Tracheostomy Timing Evidence — FRCA Final MCQ

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ModerateIntensive Care MedicineTracheostomy Timing EvidenceFRCA Final

A 60-year-old man in the ICU has been ventilated for 14 days. He has failed multiple spontaneous breathing trials. A tracheostomy is being considered. According to current evidence, what is the optimal timing for tracheostomy in patients expected to require prolonged ventilation?

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Correct answer: A — No clear optimal timing – clinical judgement required

The TracMan trial (2013) – the largest RCT comparing early (day 1-4) vs late (day ≥10) tracheostomy – showed no difference in 30-day mortality, ICU length of stay, or other outcomes. Therefore, routine early tracheostomy is not recommended for all patients. The decision should be individualised based on predicted duration of ventilation, airway safety, patient comfort, and potential for weaning. NICE and ICS do not specify a fixed timepoint.

Reference: Young D et al – 2013 – TracMan trial; ICS – 2023 – Tracheostomy guidance