title: Controversies in mechanical ventilation: when should a tracheotomy be placed?
abstract: With the large and increasing population of mechanically ventilated patients, critical care physicians frequently face the dilemma of whether to perform tracheotomy. The decision is a complex one, requiring a detailed understanding of the risks and benefits of both tracheotomy and prolonged translaryngeal intubation (TLI). It also must be individualized, taking into consideration the patient's preferences and expected clinical course. This article reviews the medical literature regarding the benefits and risks of tracheotomy as compared with TLI. The authors then discuss current data regarding the optimal timing for the procedure and propose an algorithm that may aid intensivists in clinical decision making.
authors.affiliation: Pulmonary/Critical Care Medicine, Walter Reed Army Medical Center, 3831 Rodman Street Apartment F30, Washington, DC 20016, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: King
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Moores
mesh_terms: D000075202:Contraindications; D016638:Critical Illness; D006801:Humans; D011014:Pneumonia / Q000209:etiology; D012121:Respiration, Artificial / Q000009:adverse effects; D014140:Tracheotomy; D015300:Ventilator Weaning; D014939:Work of Breathing