Tracheostomy or Endotracheal Intubation

Abstract

Current management of many critically ill and injured patients demands ventilatory support. The option of support through an endotracheal or tracheostomy tube is governed by eight factors: Shape of the tube, area of the cuff, material, illness or injury prompting respiratory support, size of the patient and airway, humidity, activity of the larynx and time involved in support. Review of our own experience and that of others prompts the conclusion that endotracheal intubation is relatively safe, should be used almost exclusively in infants, and is tolerated well by adults for periods to six days. Secondary tracheostomy will be required for adults requiring longer periods of support and those patients in whom secretions are too thick or copious to be managed by suctioning through the endotracheal tube. Obviously, there are some patients whose illness or injury will leave no option as to the route of intubation.