Timing of tracheotomy in ventilator-dependent patients.

During the last 20 years, improved critical care techniques have enhanced the probability that the condition of patients with respiratory failure will stabilize sufficiently to allow long-term mechanical ventilation. Patients undergoing the transition to prolonged ventilatory support benefit from a timely application of tracheotomy guided by a clear understanding of its risk and benefits. Although numerous investigations since 1970 compare patient outcome from tracheotomy with that after prolonged translaryngeal intubation, limitations of study design and varying results among institutions prevent absolute recommendations for timing tracheotomy. A critical review of the available data, however, allows individualization of care and an anticipatory approach to institution of the surgical airway.