Endotracheal Intubation, Extubation, and Tracheostomy: How, When, and Why?

Abstract

The timing of endotracheal intubation, extubation, or tracheostomy in neurocritical patients is a great challenge. Airway management and mechanical ventilation in these patients vary with baseline neurological disease. For this, knowledge of the pathophysiology of neurological diseases is essential, as well as of respiratory functions so that therapeutic optimization occurs. It is estimated that about 200,000 patients per year require mechanical ventilation secondary to neurological injuries. Mortality for this population ranges from 20{\%} to 50{\%}. In parallel, the costs related to mechanical ventilation of these patients are very high, and the reduction of time-dependent artificial respiration has significant economic implications. No less important than endotracheal intubation, extubation of the neurological patient also requires particular consideration of airway patency, as well as respiratory mechanics and cough reflexes. The performance of tracheostomy, whether early or late, is also widely discussed in the literature. This chapter will describe the evidence and controversies regarding endotracheal intubation, extubation, and the timing of performing a tracheostomy in patients with neurological disorders.