Indications
Indications: upper-airway obstruction, prolonged ventilation and impaired secretion clearance. Assess the underlying disease, prognosis, alternative airway strategies and family preferences before surgery. Aspiration may persist despite a tracheostomy. Shared decision
Alternatives: airway reconstruction, non-invasive respiratory support or continued endotracheal ventilation while recovery is anticipated. Repeated extubation failure requires reassessment of airway obstruction, respiratory function and neurological status.
More detail
Acute infective obstruction is usually managed with an endotracheal airway and treatment of the infection. Tracheostomy is considered when that route cannot safely establish or maintain ventilation. There is no universal maximum duration of intubation that mandates tracheostomy.