Tracheostomy - when best to perform


Respiratory tract
Respiratory medicine


Tracheostomy is a procedure that is performed for various indications, including relieving an upper airway obstruction, removing secretions and preventing laryngeal and upper airway damage from prolonged translaryngeal intubation. The latter is a significant factor recognised by clinicians, and hence as soon as the need for prolonged mechanical ventilation is identified, tracheostomy should be considered. However, the challenge lies in identifying who would require prolonged ventilatory support. Hence, this structured review explores the debate between early versus late tracheostomy and investigates the predictive factors that indicate prolonged mechanical ventilation and a subsequent tracheostomy.


Cheung NH, Napolitano LM. Tracheostomy: epidemiology, indications, timing, technique, and outcomes. Respir Care. 2014;59(6):895-915; discussion 916-899. Available from:

Stauffer JL. Complications of translaryngeal intubation. In: Tobin M. Principles and practice of mechanical ventilation. 3rd Ed. New York: McGaw Hill; 2013, chapter 39.

Durbin CG. Indications for and timing of tracheostomy. Respir Care. 2005;50(4):483-487.

Philpott C, Bennett A, Tassone P. Timing of tracheostomy in adult patients: potential ramifications are alarming. BMJ. 2005;331(7513):404. Available from:

Durbin, CG. Tracheostomy: why, when, and how? Respir Care. 2010;55(8):1056-1068.

Young D., et al. Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial. JAMA.2013;309(20):2121-2129. Available from:

Andriolo BN., et al. (2015).Early versus late tracheostomy for critically ill patients. Cochrane Database Syst Rev 1: Cd007271. Available from:

Patwa A. Shah A. Anatomy and physiology of respiratory system relevant to anaesthesia. Indian Journal of Anaesthesia. 2015;59(9):533-541. Available from:

Epstein SK. Anatomy and physiology of tracheostomy. Respir Care. 2005;50(4):476-482.

Jackson C. Humidification in the upper respiratory tract: a physiological overview. Intensive Crit Care Nurs. 1996;12(1):27-32. Available from:

Kaminsky DA. What does airway resistance tell us about lung function? Respir Care. 2012; 57(1):85-96; discussion 96-89. Available from:

Quinn M, Bhimji SS. (2017) Anatomy, airway, anatomic dead space.IN StatPearls. Available at: (accessed 1.3.18).

Duncan AW, Oh TE, Hillman DR. PEEP and CPAP. Anaesth Intensive Care. 1986;14(3):236-250. Available from:

Caramez MP. et al. Paradoxical responses to positive end-expiratory pressure in patients with airway obstruction during controlled ventilation. Crit Care Med. 2005;33(7):1519-1528. Available from:

Bhandary R. Niranjan N. (2011). Tracheostomy anaesthesia tutorial of the week 241. Available at: (accessed 1.3.18).

Mehta C. Mehta Y. Percutaneous tracheostomy. Ann Card Anaesth. 2017;20(5):19-25. Available from:

Saffl e JR. et al. Early tracheostomy does not improve outcome in burn patients. J Burn Care Rehabil. 2002;23(6):431-438. Available from:

Rumbak MJ. et al. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med. 2004;32(8):1689-1694. Available from:

Romero J. et al. Tracheostomy timing in traumatic spinal cord injury. Eur Spine J. 2009;18(10):1452- 1457. Available from:

Terragni PP. et al. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA. 2010;303(15):1483-1489. Available from:

Lee JH. et al. Effect of early vs. late tracheostomy on clinical outcomes in critically ill pediatric patients. Acta Anaesthesiol Scand. 2016;60(9):1281-1288. Available from:

Schwartz DS. (2017)Tracheomalacia. Available at: (accessed 7.12.17).

Durbin CG. et al. Should tracheostomy be performed as early as 72 hours in patients requiring prolonged mechanical ventilation? Respir Care. 2010;55(1):76- 87.

Sanabria A. et al. Prediction of prolonged mechanical ventilation in patients in the intensive care unit: a cohort study. Colomb Med (Cali). 2013;44(3):184- 188.

Heffner JE, Zamora CA. (1990). Clinical predictors of prolonged translaryngeal intubation in patients with the adult respiratory distress syndrome. Chest. 1990;97(2):447-452. Available from: