Should tracheostomy practice in the setting of trauma be standardized?

Trauma is a common predisposing condition in patients developing acute respiratory failure. Selection criteria for tracheostomy use in trauma remain poorly defined. The purpose of this review is to discuss contemporary knowledge regarding the benefits and risks of tracheostomy and to highlight potential strategies to standardize practice.

A number of studies have examined the effects of tracheostomy timing on clinically important end points. In general, these studies have produced conflicting findings, and are difficult to apply clinically. As a result, tracheostomy practice varies considerably. An approach to standardizing tracheostomy practice is presented, whereby decision for tracheostomy is based, in part, on a patient's clinical trajectory. The attractiveness of such an approach is that it attempts to match use of tracheostomy to patients with a need for continued ventilatory support.

Variation in clinical practice is costly. To the extent that variation in tracheostomy practice reflects suboptimal use of this procedure, greater understanding of tracheostomy utility has the potential to enhance the quality of care and more effectively target resources.