Early Tracheostomy in Patients Requiring Prolonged Mechanical Ventilation

Indications for Early Tracheostomy

The American Thoracic Society recommends considering tracheostomy in patients when mechanical ventilation is anticipated to be needed for more than 10-15 days, with potential benefits including more ventilator-free days, shorter ICU stays, and lower incidence of ventilator-associated pneumonia 1, 2
Early tracheostomy may offer several advantages over late tracheostomy, including more ventilator-free and sedation-free days, higher successful weaning and ICU discharge rates, potential reduction in ventilator-associated pneumonia, and fewer accidental extubations 2

A large Cochrane Database systematic review found that early tracheostomy is associated with a lower mortality rate and lower incidence of ventilator-associated pneumonia compared to late tracheostomy 1, 2
A large retrospective study demonstrated an association between early tracheostomy and decreased rates of sepsis and ventilator-associated pneumonia 2, 3

The decision to perform tracheostomy should be based on patient factors, including expected duration of mechanical ventilation, underlying disease process, patient and family preferences, and expected outcomes 2, 3, 4

Tracheostomy appears clinically useful in COVID-19 patients when prolonged ventilator support is anticipated, and should be considered when mechanical ventilation is expected to exceed 10-15 days 3