Tracheostomy in the critically ill: indications, timing and techniques.
OBJECTIVE
Tracheostomy is one of the most common procedures performed in the intensive care unit. Indications, risks, benefits, timing and technique of the procedure, however, remain controversial. The decision of when and how to perform a tracheostomy is often subjective, but must be individualized to the patient. The following review gives an update on recent literature related to tracheostomy in the critically ill.


RESULTS
Surprisingly, few data are available on the current practice of tracheostomy in the intensive care unit setting. Very few trials address this issue in a prospective, randomized fashion (randomized controlled trial). Most reports include small numbers representing a heterogeneous population, describing contrary results and precluding any definite conclusions. Evidence seems to suggest that early tracheostomy, however, might be preferable in selected patients.


CONCLUSIONS
Due to increased experience and advanced techniques, percutaneous tracheostomy has become a popular, relatively safe procedure in the intensive care unit. The question of appropriate timing, however, has not been definitely answered with a randomized controlled trial. Instead, a number of retrospective studies and a single prospective study have shed some light on this issue. Most reports favor the performance of tracheostomy within 10 days of respiratory failure.
Groves
Danja Strumper
DS
Department of Anesthesiology, University of Virginia, Charlottesville, Virginia 22908-0710, USA.
Durbin
Charles G
CG
D003422:Critical Care / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000601:surgery*; D012307:Risk Factors; D013997:Time Factors; D014139:Tracheostomy / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome