The Timing of Tracheotomy in Patients Requiring Prolonged Mechanical Ventilation

Review of the studies outlined above support the 1989 consensus statement for managing patients requiring prolonged mechanical ventilation. As related to the fourth principle recommending conversion to tracheotomy as early as possible in the course of management to minimize the duration of translaryngeal intubation, the available data suggest that the benefits of tracheotomy seem to be maximized if performed within the first 48 hours of mechanical ventilatory support. Thus, physicians should rigorously pursue tracheotomy in the more severely ill or injured patient expected to require prolonged mechanical ventilation. Concern that aggressive early tracheotomy may result in some patients undergoing an unnecessary procedure is somewhat relieved by noting that none of the more recent studies have noted any harm or adverse clinical outcomes as related to pursuing early as opposed to late tracheotomy. Future studies helping to define patient characteristics predicting need for prolonged mechanical ventilationn the various ICU patient populations are needed. It is this author's opinion that the benefits of mortality, decreased incidence of VAP, and decreased duration of hospital stay and ICU stay associated with early tracheotomy offer significant risk reduction benefits to the patient and stand to reduce cost and demands of valuable healthcare resources needed for caring for this patient population. Copyright © 2008 by Lippincott Williams & Wilkins.