Withdrawing Life Support From the Critically Ill

But what do we do in the meantime in selecting between standard tracheotomy and PDT? Although insufficient data establish that PDT is safer than the standard procedure in general populations of critically ill patients, Freeman and associates adequately support that it is just as safe in skilled hands when clinically important end points are considered. Application of PDT should depend on local expertise and practice patterns within an ICU until better outcome data emerge. But should PDT be profiled as “simple to learn and perform,” as stated in the meta-analysis introduction? Both PDT and standard surgical tracheotomy present considerable risks for acute and long-term complications. Their use for critically ill patients requires extensive procedural training, airway management skills, quality monitoring, and respect for the potential lethality of each of these invasive procedures. As taught to me by an old surgeon, there is no such thing as “simple” surgery. In the final analysis, this is one thing that we do know.