Indications for placing tracheostomy tubes can be
grouped into 4 general categories: ventilation, airway
obstruction, airway protection, and secretions. The first
category applies to patients who require long-term
mechanical ventilation because of chronic respiratory
failure, who cannot maintain respiratory function unassisted,
or who cannot be weaned from ventilatory support.
Numerous studies4-9 have been done to determine
the optimal interval from orotracheal intubation to
placement of a tracheostomy tube, but no definitive recommendations
have been made because of varied results
in different populations of patients and in patients with
different comorbid conditions. The American College of
Chest Physicians10 recommends consideration of a tracheostomy
for patients who require an endotracheal
tube for more than 21 days. Benefits of establishing a
tracheostomy rather than using an endotracheal tube
include decreasing direct laryngeal injury, improving
comfort, and improving activities of daily living such as
mobility, speech, and eating