Key messages

• In critical care, the most common role for tracheostomy is to provide a stable interface between mechanically ventilated patients and their respirators.

• The major contraindication to tracheostomy in critically ill patients is local inflammation at the proposed tracheostomy site.

• Conscious patients who are obviously experiencing severe and constant discomfort from translaryngeal intubation should be considered for tracheostomy relatively early in their courses.

• A number of techniques for tracheostomy may be employed. These include the conventional open surgical procedure, cricothyroidotomy, and percutaneous dilatation tracheostomy.

• Percutaneous tracheostomy is more economical and is associated with significantly less morbidity than the operative approach. It is increasingly considered the technique of choice in critically ill patients.

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