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 Tracheostomy is considered for the patient who is expected to require a prolonged course of mechanical ventilation or requires an artificial airway for obstruction or secretion clearance.

 For patients requiring mechanical ventilation for more than 2 weeks, it is believed that tracheostomy may be beneficial in avoiding continued injury to the vocal cords.

 Tracheostomy may be better tolerated and allow a reduction of sedation. As a consequence it facilitates physical therapy, nursing care, and transfer of the ventilated patient out from the ICU setting.

 Weaning from mechanical ventilation is also expedited due to the decreased work of breathing from a reduction of airway resistance and dead space.

 Other benefits include patient comfort such as the initiation of oral intake, communication, and mobility, and possibly fewer respiratory infections.

Table 6.1 Risks and benefits of tracheostomy.

Benefits	Risks
Secure airway Expedite weaning or transfer from ICU Facilitate nursing care Communication Patient comfort and eating Mobility/physical therapy	Pneumothorax Tracheo‐innominate artery fistula