Pro/con clinical debate: tracheostomy is ideal for withdrawal of mechanical ventilation in severe neurological impairment.
Most clinical trials on the topic of extubation have involved patients outside the neurological intensive care unit. As a result, in this area clinicians are left with little evidence on which to base their decision making. Although tracheostomies are increasingly common procedures, they are not without complications and costs, and hence a decision to perform them should not be taken lightly. In this issue of Critical Care two groups debate the merits of tracheostomy before extubation in a patient with neurological impairment. What becomes very clear is the need for more high quality data for this common clinical problem.
Luciana
L
Mascia
Eleomore
E
Corno
Pier Paok
PP
Terragni
David
D
Stather
Niall D
ND
Ferguson
D001930:Brain Injuries / Q000503:physiopathology / Q000628:therapy*; D003422:Critical Care / Q000379:methods*; D003657:Decision Making; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D011014:Pneumonia / Q000209:etiology / Q000517:prevention & control; D012121:Respiration, Artificial / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors; D014139:Tracheostomy / Q000009:adverse effects; D014474:Unconsciousness / Q000503:physiopathology; D015300:Ventilator Weaning