Bench-to-bedside review: Early tracheostomy in critically ill trauma patients

Trauma is currently one of the most important causes of morbidity and mortality in the age group between 15 to 35 years [1]. About 500,000 people are hospitalized yearly in the United States as a result of motor vehicular accident-related injuries [1]. In addition, motor vehicle-related deaths and injuries cost the United States more than $150 billion each year [1]. According to World Health Organization statistics for the year 2000, over 50% of global mortality due to road traffic accidents occurs among young adults and the mortality rates per 100,000 is in the range of 18.7 to 34.1 in the Eastern Mediterranean region and between 11.2 and 16.1 in Europe [2]. Many trauma patients require intubation and mechanical ventilation for several reasons, including relief of upper airway obstruction secondary to severe facial or laryngeal trauma, airway access in patients with cervical spine injury, management of retained airway secretions, maintenance of patent airway and airway access for prolonged mechanical ventilation [3]. The percentage of trauma patients who require tracheostomy varies considerably and ranges from 14% to 48% [4-6].Traditionally, tracheostomy has been provided for trauma patients who required endotracheal intubation for a prolonged period of time. In 1989, the American College of Chest Physicians' Consensus Conference on Artificial Airways in Patients Receiving Mechanical Ventilation recommended that tracheostomy should be considered in patients anticipated to require endotracheal intubation for more than 21 days [7]. It also recommended, however, that if tracheostomy is indicated, it should be done early to minimize the duration of translaryngeal intubation and lower the incidence of associated complications. Recently, there has been an increasing trend towards converting endotracheal intubation to tracheostomy at an earlier stage as more evidence supports the benefits of early tracheostomy [5,8-10]. Whited [11] conducted a prospective study involving