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April 21, 2010

Early vs Late Tracheotomy in ICU Patients

Author Affiliations

Author Affiliations: Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Dr Scales); Institute for Clinical Evaluative Sciences, Toronto, Ontario Canada (Dr Scales); Department of Medicine, Division of Respirology, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada (Dr Ferguson); and Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto, Toronto, Ontario, Canada (Drs Scales and Ferguson).

JAMA. 2010;303(15):1537-1538. doi:10.1001/jama.2010.462

Endotracheal intubation is the most common procedure for airway control for patients requiring mechanical ventilation. Extubation is performed once patients have improved so that mechanical ventilation can be discontinued. For patients who require prolonged mechanical ventilation, replacement of the endotracheal tube with a tracheotomy is often considered. The most common reason for tracheotomy insertion in the intensive care unit (ICU) is to provide access for prolonged mechanical ventilation. From observational data, between 6% and 11% of mechanically ventilated patients receive a tracheotomy after a median of 9 to 12 days; however, there is significant variability around both patient selection and timing.1-3