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Research ArticleConference Proceedings

Should Tracheostomy Be Performed as Early as 72 Hours in Patients Requiring Prolonged Mechanical Ventilation?

Charles G Durbin, Michael P Perkins and Lisa K Moores
Respiratory Care January 2010, 55 (1) 76-87;
Charles G Durbin Jr
Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia.
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  • For correspondence: [email protected]
Michael P Perkins
Department of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed Army Medical Center, Washington DC.
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Lisa K Moores
Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
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Abstract

Advances in treating the critically ill have resulted in more patients requiring prolonged airway intubation and respiratory support. If intubation is projected to be longer than several weeks, tracheostomy is often recommended. Tracheostomy offers the potential benefits of improved patient comfort, the ability to communicate, opportunity for oral feeding, and easier, safer nursing care. In addition, less need for sedation and lower airway resistance (than through an endotracheal tube) may facilitate the weaning process and shorten intensive care unit and hospital stay. By preventing microaspiration of secretions, tracheostomy might reduce ventilator-associated pneumonia. There is controversy, however, over the optimal timing of the procedure. While there have been many randomized controlled trials on tracheostomy timing, most were insufficiently powered to detect important differences, and systematic reviews and meta-analyses are limited by the heterogeneity of the primary studies. Based on the available data, we think it is reasonable to perform early tracheostomy in all patients projected to require prolonged mechanical ventilation. Unfortunately, identifying those patients can be difficult, and for many patient populations we lack the necessary tools to predict prolonged ventilation. We propose an early-tracheostomy decision algorithm.

  • respiratory failure
  • tracheostomy
  • intubation
  • mechanical ventilation
  • weaning
  • critical care
  • timing

Footnotes

  • Correspondence: Charles G Durbin Jr MD FAARC, Department of Anesthesiology, University of Virginia Health Science Center, PO Box 800710, Charlottesville VA 22908-0170. E-mail: cgd8v{at}virginia.edu.
  • Drs Durbin and Moores presented a version of this paper at the 44th Respiratory Care Journal Conference, “Respiratory Care Controversies II,” held March 13-15, 2009, in Cancún, Mexico.

  • The authors have disclosed no conflicts of interest.

  • The views expressed in this paper are those of the authors and do not necessarily reflect those of the United States Army, Department of Defense, or the United States government.

  • Copyright © 2010 by Daedalus Enterprises
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Respiratory Care: 55 (1)
Respiratory Care
Vol. 55, Issue 1
1 Jan 2010
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Should Tracheostomy Be Performed as Early as 72 Hours in Patients Requiring Prolonged Mechanical Ventilation?
Charles G Durbin, Michael P Perkins, Lisa K Moores
Respiratory Care Jan 2010, 55 (1) 76-87;

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Should Tracheostomy Be Performed as Early as 72 Hours in Patients Requiring Prolonged Mechanical Ventilation?
Charles G Durbin, Michael P Perkins, Lisa K Moores
Respiratory Care Jan 2010, 55 (1) 76-87;
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Keywords

  • respiratory failure
  • tracheostomy
  • intubation
  • mechanical ventilation
  • weaning
  • critical care
  • timing

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