title: Evidence-based guidelines for the use of tracheostomy in critically ill patients.
abstract: To provide evidence-based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research.
  
  
  
  A taskforce composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system.
  
  
  
  The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified, of which 226 publications were chosen. The taskforce generated a total of 19 recommendations, 10 positive (1B, 3; 2C, 3; 2D, 4) and 9 negative (1B, 8; 2C, 1). A recommendation was not possible in 6 questions.
  
  
  
  Percutaneous techniques are associated with a lower risk of infections compared with surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.
authors.affiliation: Hospital Municipal Juan A. Fernández, Universidad de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Néstor
authors.initials: N
authors.lastname: Raimondi
authors.affiliation: MD Anderson Cancer Center, The University of Texas, Houston, TX, USA; Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile.
authors.forename: Macarena R
authors.initials: MR
authors.lastname: Vial
authors.affiliation: Hospital Zambrano Hellion, Instituto Tecnológico de Monterrey, Monterrey, México.
authors.forename: José
authors.initials: J
authors.lastname: Calleja
authors.affiliation: Instituto Médico de Alta Tecnología, Universidad del Sinú, Montería, Córdoba, Colombia.
authors.forename: Agamenón
authors.initials: A
authors.lastname: Quintero
authors.affiliation: Clínica Mayor de Temuco, Hospital de Nueva Imperial, Universidad Mayor de Temuco, Temuco, Chile.
authors.forename: Albán
authors.initials: A
authors.lastname: Cortés
authors.affiliation: Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Colombia.
authors.forename: Edgar
authors.initials: E
authors.lastname: Celis
authors.affiliation: Hospital Universitario de Caracas, Caracas, Venezuela.
authors.forename: Clara
authors.initials: C
authors.lastname: Pacheco
authors.affiliation: Hospital del Salvador, Clínica Indisa, Universidad de Chile, Santiago, Chile.
authors.forename: Sebastián
authors.initials: S
authors.lastname: Ugarte
authors.affiliation: Hospital Universitario La Paz-Carlos III. IdiPaz, Madrid, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Añón
authors.affiliation: Complejo Hospitalario de Toledo, Toledo, Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Hernández
authors.affiliation: Hospital Ángeles Lomas, Hospital Español de México, Ciudad de México, México.
authors.forename: Erick
authors.initials: E
authors.lastname: Vidal
authors.affiliation: Hospital Juan A. Fernández CABA, Universidad de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Chiappero
authors.affiliation: Hospital Nacional Alejandro Posadas, Sanatorio Las Lomas, San Isidro, Buenos Aires, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Ríos
authors.affiliation: Hospital Zambrano Hellion, Instituto Tecnológico de Monterrey, Monterrey, México.
authors.forename: Fernando
authors.initials: F
authors.lastname: Castilleja
authors.affiliation: Complejo Hospitalario Caja de Seguro Social, Ciudad de Panamá, Panamá.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Matos
authors.affiliation: Complejo Hospitalario Caja de Seguro Social, Ciudad de Panamá, Panamá.
authors.forename: Enith
authors.initials: E
authors.lastname: Rodriguez
authors.affiliation: Hospital Santa Casa de Ribeirão Preto, Centro Universitário Barao de Maua, São Paulo, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Antoniazzi
authors.affiliation: Hospital de Urgências de Goiânia, Goiás, Brazil.
authors.forename: José Mario
authors.initials: JM
authors.lastname: Teles
authors.affiliation: Gestión Salud, Santa Cruz de Bocagrande, Universidad de Cartagena, Cartagena, Colombia.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Dueñas
authors.affiliation: Hospital Punta Pacífica, Johns Hopkins Medicine, Universidad de Panamá, Ciudad de Panamá, Panamá.
authors.forename: Jorge
authors.initials: J
authors.lastname: Sinclair
authors.affiliation: Hospital Policlínica Metropolitana, Caracas, Venezuela.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Martínez
authors.affiliation: Hospital Central "Miguel Pérez Carreño" IVSS, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Ingrid
authors.initials: I
authors.lastname: von der Osten
authors.affiliation: Hospital Luis Vernaza, Universidad de Especialidades Espíritu Santo "UEES,", Guayaquil, Ecuador.
authors.forename: José
authors.initials: J
authors.lastname: Vergara
authors.affiliation: Baylor Scott & White Health, Texas A&M Health Science Center College of Medicine, Temple, TX, USA.
authors.forename: Edgar
authors.initials: E
authors.lastname: Jiménez
authors.affiliation: Clínica Santa Sofía, Caracas, Venezuela.
authors.forename: Max
authors.initials: M
authors.lastname: Arroyo
authors.affiliation: Instituto Médico de Alta Tecnología, Universidad del Sinú, Montería, Córdoba, Colombia.
authors.forename: Camilo
authors.initials: C
authors.lastname: Rodríguez
authors.affiliation: Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile.
authors.forename: Javier
authors.initials: J
authors.lastname: Torres
authors.affiliation: Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile; Division of Pulmonary, Critical Care & Sleep Medicine, University of Florida, Gainesville, FL.
authors.forename: Sebastián
authors.initials: S
authors.lastname: Fernandez-Bussy
authors.affiliation: MD Anderson Cancer Center, The University of Texas, Houston, TX, USA. Electronic address: jlnates@mdanderson.org.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Nates
mesh_terms: D026683:Advisory Committees; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy*; D019317:Evidence-Based Medicine; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D011014:Pneumonia / Q000453:epidemiology; D012121:Respiration, Artificial / Q000379:methods*; D012955:Societies, Medical; D013997:Time Factors; D014139:Tracheostomy / Q000191:economics / Q000379:methods*
keywords: Clinical guidelines; Consensus; Critical care; Intensive care unit; Percutaneous; Tracheostomy