When should a mechanically ventilated patient undergo tracheostomy?

摘要

EACH YEAR, APPROXIMATELY 800 000 US RESIDENTS UN-dergo mechanical ventilation for acute respiratory insufficiency, often for a period of days or weeks. Although mechanical ventilation can be lifesaving, it is unnatural and invasive, can be extremely uncomfortable, and requires expensive intensive care support. Endo-tracheal intubation is the most efficient and convenient method by which to initiate mechanical ventilation. However, intubation is often not well tolerated by an awake patient; is prone to potentially disastrous dislodgement; and interferes with oral care, feeding, and communication.