Recent Updates of Insertion and Management of Tracheostomy in Adult Critically Ill Patients

Abstract

Tracheostomy is one of the most common intensive care unit procedures performed. Recent Advances and improvements in treating critically ill patients have resulted in more patients requiring prolonged airway and respiratory support, the frequency of tracheostomy use in critically ill patients has increased over the last decade. Despite the frequency of the procedure, there remains controversy regarding selection of patients who should undergo tracheostomy, the optimal technique, timing of placement and decannulation, as well as impact on outcome associated with the procedure. The decision of when and how to perform a tracheostomy is often subjective, but must be individualized to the patient. Optimal timing of tracheostomy should includeconsiderations of the risks of the procedure itself and the expected benefits including shortened duration of mechanical ventilation, shortened length of stay (LOS) in the ICU and hospital, decreased morbidity and mortality, and improved utilization of ICU resources and reduced costs. Different definitions of early and latetracheostomy and morbidity make comparisons between studies difficult. Despite the existence of various techniques, the key to successful performance of a tracheostomy and management of patients with a tracheostomy is standardization. It is vital to select one technique and become expert in its use.