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Crit Care Clin. 2017 Apr;33(2):311-322. doi: 10.1016/j.ccc.2016.12.007.

Tracheostomy Update: When and How.

Freeman BD1.
Author information

Department of Surgery, Washington University School of

Medicine, 660 South Euclid Avenue, Box 8109, St Louis, MO
63110, USA. Electronic address: freemanb@wustl.edu

Abstract
Tracheostomy remains one of the most commonly performed
surgical procedures in the setting of acute respiratory failure.
Tracheostomy literature focuses on 2 aspects of this procedure:
when (timing) and how (technique). Recent trials have failed to
demonstrate an effect of tracheostomy timing on most clinically
important endpoints. Nonetheless, relative to continued
translaryngeal intubation, studies suggest that tracheostomy
use is associated with less need for sedation and enhanced
patient comfort. Evidence likewise suggests that percutaneous
dilational tracheostomy is advantageous with respect to cost
and complication profile and should be considered the preferred
approach in appropriately selected patients.
KEYWORDS:
Acute respiratory failure; Critical illness; Intensive care units;
Percutaneous dilational tracheostomy; Practice variation; Tracheostomy