When and how should we do a tracheostomy?

Tracheostomy is one of the most common surgical procedures in the intensive care unit. Since the introduction of percutaneous techniques, tracheostomy has become increasingly popular. The technique is relatively easy, and the early and late complication rates are relatively low.It is unknown at which moment tracheostomy can best be performed in the translaryngeally intubated patient. There are theoretic arguments for both early and late tracheostomy. The excellent results of percutaneous tracheostomy may influence the decision to perform a tracheostomy rather early, but prospective randomized studies are required to gather the necessary evidence.