Tracheostomy in Intubated Patients

Abstract

In Brief Temporary tracheostomy (TT) is a common critical care procedure in patients with acute respiratory failure who require prolonged mechanical ventilatory support. Usually TT is considered if weaning from mechanical ventilation has been unsuccessful, but both the timing and the method to perform are still controversial. A clinical trial by Rumback suggested that early TT may benefit patients who are not improving and who are expected to require prolonged respiratory support. In that study, early TT improved survival and shortened duration of mechanical ventilation, although other studies found no benefit. Minimally invasive bedside percutaneous TT (PTT) was introduced as an alternative to the traditional surgical technique. In expert hands, both techniques are equivalent in complications and safety; however, the PTT approach may be more cost-effective. Early PTT should be considered in patients with a high likelihood of prolonged mechanical ventilation. The authors introduce a modification of a device used for PTT. Surgical technique should be used when PTT is contraindicated Temporary tracheostomy is a common critical care procedure in patients with acute respiratory failure who require prolonged mechanical ventilatory support, but when and how should it be performed are still controversial. We review the state of the art of temporary tracheostomy along with some new aspects that in our experience improve this procedure.