Abstract
Tracheostomy in critically ill patients offers a number of practical and theoretical advantages compared with conventional translaryngeal orotracheal or nasotracheal intubation. Recent reports suggest that it might be possible to identify factors that allow physicians to determine which patients will be most likely to benefit from tracheostomy. However, the appropriate timing still remains controversial. A body of evidence exists that indicates that tracheostomy in intensive care patients, regardless of the method chosen, should be performed at the bedside. The technique of percutaneous dilatational tracheostomy has been studied in many patients, demonstrating an at least comparable rate of perioperative and a lower rate of postoperative complications compared with conventional open surgical tracheostomy. Based on these results, and taking into account the fact that the use of percutaneous dilatational tracheostomy in the intensive care setting offers some additional logistic advantages, it is the first line method for critically ill patients.
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