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 Early tracheostomy is variably defined, and generally performed within 4 days of intubation.

 Earlier tracheostomy is considered if the likelihood of intubation is recognized to be prolonged beyond 2 weeks.

 Patient discomfort secondary to translaryngeal intubation and multiple failed extubation attempts may also support earlier tracheostomy.

 The benefits for earlier intervention are not clear. In some studies, such as in patients with traumatic brain injury or subarachnoid hemorrhage, reductions in length of stay (LOS) and pulmonary infections have been seen. However, in these neurosurgical populations, patients are often considered for earlier tracheostomy due to mental status issues and fear of weaning. A review and meta‐analysis also indicated early tracheostomy placement reduced the duration of mechanical ventilation and hospital stay.

 There is no definitive mortality benefit for early tracheostomy.

 In general, the decision for tracheostomy should begin with an evaluation of the patient within a week of intubation as to the likelihood of extubation in the upcoming week. The first week’s course is often predictive of ventilator dependency.