Tracheostomy in Mechanical Ventilation

Airway access for mechanical ventilation (MV) can be provided either by orotracheal
intubation (OTI) or tracheostomy tube. During episodes of acute respiratory failure,
patients are commonly ventilated through an orotracheal tube that represents an easy
and rapid initial placement of the airway device. OTI avoids acute surgical complications
such as bleeding, nerve and posterior tracheal wall injury, and late complications such as
wound infection and tracheal lumen stenosis that may emerge due to tracheostomy
tube placement. Tracheostomy is often considered when MV is expected to be applied
for prolonged periods or for the improvement of respiratory status, as this approach
provides airway protection, facilitates access for secretion removal, improves patient
comfort, and promotes progression of care in and outside the intensive care unit (ICU).
The aim of this review is to assess the frequency and performance of different surgical or
percutaneous dilational tracheostomy and timing and safety procedures associated
with the use of fiberoptic bronchoscopy and ultrasounds. Moreover, we analyzed the
performance based on National European surveys to assess the current tracheostomy
practice in ICUs.