Reply to comment on: "Safety of percutaneous dilational tracheostomy in patients ventilated with high positive end-expiratory pressure"

Excerpt

Cakar et al. argue that percutaneous dilational tracheostomy (PDT) is an elective intervention and therefore should be performed after stabilization of oxygenation after 48–72 h, as recently described [1]. We agree wholeheartedly since this reflects our clinical practice [2]. PDT was performed in nearly all patients after initial stabilization and after elapse of 5 days (median), as easily seen in Table 2. While in our ARDS and ECMO center we observe similar courses of improvement in our patients as others [1], there is, however, an important difference. Our patients had a much more impaired oxygenation at the beginning of ARDS and even after initial stabilization (PEEP of 17±4 vs. 8.7±5.5 mbar and a PaO₂/FIO₂ ratio of 130±42 vs. 141±55 mmHg). Furthermore, as suggested by an overall mortality of 61%, obviously not all ARDS patients improve within 72 h [1]. Thus to optimize mechanical ventilation and handling of these severely compromised patients PDT is performed after the attempt of initial stabilization. …