Critical care : the official journal of the Critical Care Forum
-
Most clinical trials on the topic of extubation have involved patients outside the neurological intensive care unit. As a result, in this area clinicians are left with little evidence on which to base their decision making. ⋯ In this issue of Critical Care two groups debate the merits of tracheostomy before extubation in a patient with neurological impairment. What becomes very clear is the need for more high quality data for this common clinical problem.
-
Percutaneous dilatation tracheostomy in the intensive care setting presents an increasingly important concept for establishing a large-bore tracheal airway with minimal surgical intervention. Over the last years, different technical solutions have been studied to assess their respective risks and benefits to determine whether one method is actually superior. A recent observational study comparing two such techniques prompted this commentary, which reviews the current literature, comments on study design and suggests interesting topics for future research in this field.