[Tracheostomy in the intensive care unit]

Indication, timing and technique of tracheostomy have undergone considerable changes during the past years. Percutaneous tracheostomy has become a standard procedure in modern intensive care. It can be performed by the intensive medicine specialists themselves with low complication rates. Advantages are less stomal infections, better cosmetic results and cost savings in comparison to the surgical technique. Exact knowledge of the anatomic details, careful attention to contraindications and bronchoscopic supervision throughout the procedure are essential for optimal results. Exchange of the tracheostomy tube requires adequate preparation and training. If contraindications exist or permanent mechanical ventilation can be anticipated, surgical tracheostomy is indicated. The optimal timing of tracheostomy remains controversial.