Tracheostomy in mechanical ventilation

Endotracheal intubation is commonly used for airway control, while tracheostomy is a procedure indicated for patients who suffer from respiratory failure and need prolonged mechanical ventilation. Between 6% and 11% of mechanically ventilated patients receive a tracheostomy that allows for a lower sedation and shorter weaning time leading to a reduction in intensive care unit (ICU) and hospital stay. The technique and timing of tracheostomy are still controversial in the literature. Percutaneous dilational tracheostomy techniques, performed at the bedside in the ICU, are widely used, but there are still patients (with severe coagulation disorders or cervical spine injury) who can benefit from the surgical “minimally invasive” techniques. The correct timing is also under debate but, excluding patients with severe brain or cervical spine injury, we can reasonably affirm that tracheostomy should not be performed earlier than 2 weeks following respiratory failure.