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May 22, 2013

When Should a Mechanically Ventilated Patient Undergo Tracheostomy?

Author Affiliations

Author Affiliations: The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr Angus is also Contributing Editor, JAMA.

JAMA. 2013;309(20):2163-2164. doi:10.1001/jama.2013.6014

Each year, approximately 800 000 US residents undergo mechanical ventilation for acute respiratory insufficiency, often for a period of days or weeks.1 Although mechanical ventilation can be lifesaving, it is unnatural and invasive, can be extremely uncomfortable, and requires expensive intensive care support. Endotracheal intubation is the most efficient and convenient method by which to initiate mechanical ventilation. However, intubation is often not well tolerated by an awake patient; is prone to potentially disastrous dislodgement; and interferes with oral care, feeding, and communication.