Tracheostomy practice in adults with acute respiratory failure

Area of Science:

• Critical Care Medicine
• Surgical Procedures
• Respiratory Medicine

Background:

• Tracheostomy is a frequent surgical procedure for adults with acute respiratory failure.
• This patient group requires intensive healthcare resources.
• Current knowledge on tracheostomy practice needs synthesis.

Purpose of the Study:

• To synthesize current knowledge on tracheostomy practice in adults with acute respiratory failure.
• To review indications, timing, technique, and management of tracheostomy.

Main Methods:

• Systematic review of peer-reviewed, English-language publications.
• Focus on tracheostomy indications, timing, technique, and management.

Main Results:

• Early tracheostomy (within 2 weeks) did not significantly impact mortality or complications in large trials.
• Tracheostomy, compared to translaryngeal intubation, reduced sedation and improved mobility.
• Percutaneous dilational tracheostomy is more cost-effective and has a better complication profile than conventional surgical methods.
• Limited evidence exists for post-tracheostomy management recommendations.

Conclusions:

• Defer tracheostomy for at least 2 weeks in acute respiratory failure unless specific indications exist.
• Consider earlier tracheostomy for subpopulations like those with neurological injury or stroke.
• Percutaneous dilational tracheostomy is the preferred technique.
• Future research should focus on optimizing post-tracheostomy care and patient-centered outcomes.