PT  - JOURNAL ARTICLE
AU  - Paul T. Engels
AU  - Sean M. Bagshaw
AU  - Michael Meier
AU  - Peter G. Brindley
TI  - Tracheostomy: from insertion to decannulation
DP  - 2009 Oct 01
TA  - Canadian Journal of Surgery
PG  - 427--433
VI  - 52
IP  - 5
4099  - http://canjsurg.ca/content/52/5/427.short
4100  - http://canjsurg.ca/content/52/5/427.full
SO  - CAN J SURG2009 Oct 01; 52
AB  - Tracheostomy is a common surgical procedure, and is increasingly performed in the intensive care unit (ICU) as opposed to the operating room. Procedural knowledge is essential and is therefore outlined in this review. We also review several high-quality studies comparing percutaneous dilational tracheostomy and open surgical tracheostomy. The percutaneous method has a comparable, if not superior, safety profile and lower cost compared with the open surgical approach; therefore the percutaneous method is increasingly chosen. Studies comparing early versus late tracheostomy suggest morbidity benefits that include less nosocomial pneumonia, shorter mechanical ventilation and shorter stay in the ICU. However, we discuss the questions that remain regarding the optimal timing of tracheostomy. We outline the potential acute and chronic complications of tracheostomy and their management, and we review the different tracheostomy tubes, their indications and when to remove them.