Abstract
When it is necessary to perform airway management in a patient with exacerbated respiratory disease, the first choice is endotracheal intubation. However, when mechanical ventilation is prolonged, it is considered more practical to perform a tracheostomy after assessing the risks and benefits of ventilation via endotracheal intubation or via a tracheostomy tube and the pathological features of the respiratory disease. With regard to timing of the switch from endotracheal intubation to tracheostomy, it is considered desirable to perform the tracheostomy within 10 days if the patient cannot become independent of mechanical ventilation by 7 days after endotracheal intubation. The tracheostomy tube is removed when the patient no longer needs mechanical ventilation, no upper airway obstruction is observed, the amount of secretions has decreased, and peak cough expiratory flow is adequate. In actual practice, the tube is removed after accurately assessing each patient's respiratory status.
