Tracheostomy timing, enrollment and power in ICU clinical trials

Excerpt

Tracheostomy is provided to between 5 and 11% of patients requiring mechanical ventilation, accounting for 26% of all ventilator days and 14% of all hospital days [1, 2]. The procedure has several theoretical advantages over continued endotracheal intubation, including the potential to improve patient comfort and communication, decrease sedation requirements, and facilitate liberation from mechanical ventilation [3]. However, tracheostomy is not without risk. A strategy of prolonged intubation may allow for many patients to be successfully liberated from mechanical ventilation without the potential for adverse events that are associated with the procedure [4]. These concerns result in an ongoing debate about the optimal timing of tracheostomy in the intensive care unit (ICU). Indeed, randomized trials in this area show mixed results [5], and wide variations in practice patterns persist [6]. …