Tracheostomy Appropriateness and indications in cancer patients

Increased survival in cancer patients and increased use of immunosuppressive treatments has resulted in a higher number of cancer patients admitted to intensive care units (ICUs). Tracheostomy is the most commonly performed procedure in ICUs, so the question of the appropriateness of tracheostomy is one clinicians will face even more in the coming years. The main benefits of tracheostomy in critically ill cancer patients are often clear in cases with upper airway obstruction, but this is not the case in prolonged mechanical ventilation. The main benefit appears to be an overall reduction in the duration of mechanical ventilation. In order to maximize this benefit, tracheostomy should be performed as early as possible, but unfortunately, clinicians are not good at predicting who will require prolonged mechanical ventilation. Therefore, the benefit has to be weighed against the risk of performing unnecessary procedures, and ideally, it should not be performed before 7 days of endotracheal intubation. Finally and more importantly, appropriateness will depend on the overall plan of care and prognosis of the underlying malignancy.