No abstract

MECHANICAL VENTILATION REQUIRING cannulation of the trachea is an integral part of the therapy provided to patients in the surgical critical care setting. In the 1950s and early 1960s, airway management consisted of a short period of translaryngeal intubation quickly converted to tracheostomy. In the late 1960s and 1970s the time of translaryngeal intubation before tracheostomy gradually increased with the development of improved endotracheal tube design and construction. This concept became the standard of care in critical care units,'-6 irrespective of the type of patient cared for. In the late 1970s and early 1980s Dane and King; El Naggar et a1.,8 and Stauffer et al.9 compared translaryngeal intubation with tracheostomy in critically ill patients. Outcome analyses centered solely on the complications of tracheostomy and risk of tracheal stenosis. These studies have frequently been cited to demonstrate the dangers of tracheostomy and the high incidence of morbidity and death as a result of the procedure and supported prolonged translaryngeal intubation to avoid tracheostomy until absolutely necessary. In several well-performed prospective studies,"-12 the controversy concerning perioperative morbidity and death and timing of tracheostomy after translaryngeal intubation were addressed. These reports demonstrated that morbidity and mortality rates of tracheostomy were low and translaryngeal intubation of less than 7 days was associated with a risk of transient laryngeal injury of less than 10%. Tracheostomy after 7 days of translaryngeal intubation had a significant incidence of irreversible laryngeal and tracheal stenosis. On the other hand, in a prospective,