LandmarkRCT

TracMan

Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial.

JAMA, 2013 · Multicenter randomized trial

Population: 909 UK general ICU adults expected to need prolonged support
Intervention: Early tracheostomy within four days
Comparator: Deferred strategy after day ten if still indicated
Primary outcome: 30-day all-cause mortality
Result: 30.8% versus 31.5%; no significant difference. Many deferred patients did not undergo tracheostomy.

What the trial found

30.8% versus 31.5%; no significant difference. Many deferred patients did not undergo tracheostomy.

Clinical interpretation

No routine early survival benefit; prediction of prolonged ventilation is imperfect. Neutrality does not prove subgroup equivalence.

Moderate certainty

Clinical Context & Relevant Topics (1)

Disease Reference

Systematic evaluation of failed liberation, tracheostomy timing/selection, cuff and secretion management, and multidisciplinary weaning.