Abstract
Tracheostomy is one of the most frequent procedures performed in intensive care unit (ICU) patients. Of the many purported advantages of tracheostomy, only patient comfort, early movement from the ICU, and shorter ICU and hospital stay have significant supporting data. Even the belief of increased safety with tracheostomy may not be correct. Various techniques for tracheostomy have been developed; however, use of percutaneous dilation techniques with bronchoscopic control continue to expand in popularity throughout the world. Tracheostomy should occur as soon as the need for prolonged intubation (longer than 14 d) is identified. Accurate prediction of this duration by day 3 remains elusive. Mortality is not worse with tracheotomy and may be improved with earlier provision, especially in head-injured and critically ill medical patients. The timing of when to perform a tracheostomy continues to be individualized, should include daily weaning assessment, and can generally be made within 7 days of intubation. Bedside techniques are safe and efficient, allowing timely tracheostomy with low morbidity.
Footnotes
- Charles G Durbin Jr MD FAARC, Department of Anesthesiology, University of Virginia, Box 800710, Charlottesville VA 22908. E-mail: cgd8v{at}virginia.edu.
Dr Durbin presented a version of this paper at the 25th New Horizons Symposium, “Airway Management: Current Practice and Future Directions,” at the 55th International Respiratory Congress of the American Association for Respiratory Care, held December 5–8, 2009, in San Antonio, Texas.
The author has disclosed no conflicts of interest.
- Copyright © 2010 by Daedalus Enterprises Inc.
