Evidence-based management of tracheostomies in hospitalized patients.

There is little evidence-based literature on the management of tracheostomized patients. The existing data relate to the role of tracheostomy in specific disease states, the timing of tracheostomy, and comparison of open surgical to percutaneous tracheostomy. Tracheostomy protocols are under development. A recent series of 1,130 patients who underwent tracheostomy had a combined procedural, early, and late complication rate of approximately 4%, which is an improvement from the earlier complication rate. In the recent series, tracheal stenosis overtook hemorrhage as the leading complication, by 2 to 1. Tracheal stenosis accounted for nearly half of the complications. Half of the tracheal stenoses required surgical correction. All the patients who developed tracheal stenosis had endotracheal tubes for > 12 days before tracheostomy.