Tracheostomy in the critically ill patient: Who, when, and how? A review

Tracheostomy in the ICU has evolved into a bedside procedure being done by nonsurgeons and is becoming more popular among intensivists worldwide as a means of controlling the airway in critically ill patients. This review article evaluates the current literature that addresses on whom, when, and with which technique this procedure is being performed. Europe and the United States have similar practices of whom and when a tracheostomy should be performed; however, the Europeans have more experience with the various percutaneous tracheostomy techniques. Thus far, the literature favors the use of tracheostomy in those patients with an expected mechanical ventilation time ranging from 1 to 2 weeks, but early tracheostomy in this group suggests a favorable trend toward fewer ventilator days, ICU days, and overall costs. Percutaneous tracheostomy is the preferred method for bedside tracheostomy tube placement in the ICU, but the method is still evolving and the best technique has yet to be defined.