Happy New Year! <img src="https://ventworld.infopop.cc/groupee_common/emoticons/icon_smile.gif" alt="Smile" width="15" height="15"><!--graemlin::)--><BR><BR>This is a poll to find out whether or not there are set standards/protocols at facilities when to trach a patient.<BR>This is an open discussion between my facility's trauma/surgical staff and medicine staff.<BR>It was brought up again at our last meeting and made me think: Are we missing something and/or is there data out there to suggest different.<BR><BR>Each physician has their own personal opinion about this topic. Also, what type of trach procedure is your facility doing: percutaneous vs. surgical?<BR><BR>Thanks,<BR>WadeHow many days on a vent before deciding when to trach a patient?3-5 days6-10 days14 days or greaterDepends on patient's injuries/diseaseOtherPercutaneous vs. surgical?PercutaneousSurgical

Happy New Year to all as well. Great question Wade, and well set up with the poll. I am currently at an LTAC and we try to get patients before they are trached. We have about 70% success rate at getting them extubated without needing to trach them. If they need a trach we can do a perc. So as to when to trach, if there is a chance of getting them to a center that specializes on weaning, and can do trachs even if the move is not real feasible until 2 weeks in consider leaving the ETT and let the weaning center have a chance at extubating. I consider the trach better in general and fully understand the trach as early as it seems like weaning will not occur quickly mentality unless it was my neck, then I might feel differently. As to perc or surgical trach, my experience with both leads me to feel that the percs are better. The stoma is tighter to the shaft of the tube and there is less mess (upper airway secretions passing the stoma, blood etc on the pad) and seems to me less infection in those I have seen. I have seen some breakdown resultant from the bruising that comes with the dilation of the percs, but that is far rarer than a purulent draining surgical stoma site.

I agree with Gary. I have seen to many Columbian Necktie surgical trachs the are a disaster to heal upon decannulation. As far as traching a patient I beleive that it should be dependent of the projected patient outcome.