A critically ill patient requiring mechanical ventilation should be considered for a tracheostomy if one or more indications are present.
Indications for considering mechanical ventilation:
(1) presence of shock on day 1 of mechanical ventilation
(2) APACHE II score > 25
(3) persistent requirement for mechanical ventilation on day 7 despite optimal management
(4) PaO2 to FIO2 ratio not improving or worse
Optimal management for a patient requiring mechanical ventilation:
(1) daily assessment for weaning and condition requiring intubation
(2) daily interruption of sedation
(3) tight glucose control
(4) elevation of the head of the bed
(5) assessment for noninvasive ventilation
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Purpose: To determine if a critically ill patient who requires mechanical ventilation should be considered for a tracheostomy.