Timing of tracheostomy in patients with prolonged endotracheal intubation

Abstract

Tracheostomy is creating a stoma at the surface of the skin leading into the trachea. It is a frequently performed procedure in about 24% of ICU patients as it has many advantages over prolonged endotracheal intubation as: reducing oropharyngeal and laryngeal trauma, reducing work of breathing by decreasing airway dead space and lowering the airway resistance, improving pulmonary secretion clearance, reducing the use of sedation and decreasing the duration of mechanical ventilation and consequently length of ICU and hospital stay. Tracheostomy is indicated in severe upper airway obstruction, patients expected to require prolonged mechanical ventilation for at least two weeks, clearing secretions from the airways through the tracheostomy tube or as a part of another procedure. However, prolonged endotracheal intubation is the most common indication for tracheostomy. The optimal timing of tracheostomy in patients requiring prolonged endotracheal intubation is still a debate despite its advantages. The National Association of Medical Directors of Respiratory Care in 1989 stated that tracheostomy is indicated if mechanical ventilation is to be continued for more than 21 days while patients requiring mechanical ventilation for less than 10 days are candidates for endotracheal intubation. Other authors recommended early tracheostomy while others mentioned that the evidence of the benefits of tracheostomy over endotracheal intubation is insufficient. This meta-analysis aimed to evaluate the appropriate timing of tracheostomy in patients with prolonged intubation regarding the incidence of