Indications for Tracheotomy
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.11