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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