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Terragni PP, Antonelli M, Fumagalli R et al.

University of Turin, Turin, Italy.

 JAMA 2010;303:1483–9.

Editor’s note: Tracheotomy is used to replace endotracheal intubation in patients requiring prolonged support. However, there is considerable variability in the time considered optimal to perform the procedure. This important randomized controlled trial performed in 12 Italian intensive care units (ICUs) over a 4-year period included 600 adult patients without lung infection who had been ventilated for >24 h. Those who had worsening respiratory conditions, unchanged or worsening sequential organ failure assessment scores, but no pneumonia 48 h after inclusion were randomized to receive either early (n=209) or late (n=210) tracheotomy. Overall, 145 patients received early tracheotomy (after a mean of 7 days) and 119 patients received late tracheotomy (after a mean of 14 days). Patients who did not receive the planned procedure were still included in the analysis because of the intention-to-treat design.

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