Does early versus late tracheotomy afford benefits in ventilated patients?

Since the 1970s, different comparative studies have tried to answer this question. The two randomized, prospective multicenter trials with the largest sample size to date have been published during the last 5 years. In the first of them, Terragni et al. included 419 patients, of which 209 were randomized to early tracheotomy (after 6--8 days of translaryngeal intubation [TI]) and 210 to late tracheotomy (after 13--15 days of TI). The primary endpoint was the incidence of ventilator-associated pneumonia (VAP). The authors found no differences between the two groups in terms of either the primary endpoint or mortality after 28 days (secondary endpoint). The overall complications rate was 39%, though the majority were only minor problems. The second and most recent study was published by Young et al. (The TracMan randomized trial), and included 909 patients, of which 455 were randomized to early tracheotomy (during the first 4 days of TI) and 454 to late tracheotomy (after 10 days of TI). There were no differences between the two groups in terms of mortality 30 days after randomization (primary endpoint) or as regards in-hospital mortality or mortality after one and two years of follow-up. In the study published by Terragni et al., 17% (n = 36) of the patients randomized to early tracheotomy and 20%