Should tracheostomy be performed as early as 72 hours in patients requiring prolonged mechanical ventilation?

Charles G. Durbin, Michael P. Perkins, Lisa K. Moores

Research output: Contribution to journalArticlepeer-review

59 Scopus citations


Advances in treating the critically ill have resulted in more patients requiring prolonged airway intubation and respiratory support. If intubation is projected to be longer than several weeks, tracheostomy is often recommended. Tracheostomy offers the potential benefits of improved patient comfort, the ability to communicate, opportunity for oral feeding, and easier, safer nursing care. In addition, less need for sedation and lower airway resistance (than through an endotracheal tube) may facilitate the weaning process and shorten intensive care unit and hospital stay. By preventing microaspiration of secretions, tracheostomy might reduce ventilator-associated pneumonia. There is controversy, however, over the optimal timing of the procedure. While there have been many randomized controlled trials on tracheostomy timing, most were insufficiently powered to detect important differences, and systematic reviews and meta-analyses are limited by the heterogeneity of the primary studies. Based on the available data, we think it is reasonable to perform early tracheostomy in all patients projected to require prolonged mechanical ventilation. Unfortunately, identifying those patients can be difficult, and for many patient populations we lack the necessary tools to predict prolonged ventilation. We propose an early-tracheostomy decision algorithm.

Original languageEnglish
Pages (from-to)76-83
Number of pages8
JournalRespiratory Care
Issue number1
StatePublished - Jan 2010
Externally publishedYes


  • Critical care
  • Intubation
  • Mechanical ventilation
  • Respiratory failure
  • Timing
  • Tracheostomy
  • Weaning


Dive into the research topics of 'Should tracheostomy be performed as early as 72 hours in patients requiring prolonged mechanical ventilation?'. Together they form a unique fingerprint.

Cite this