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Subjects: All patients in the three medical ICUs who were intubated and mechanically ventilated for acute respiratory failure were screened and included if they were: >18 years old, projected to need mechanical ventilation >14 days, and had an initial APACHE II score >25. Specific exclusion criteria were established to ensure the safe performance of percutaneous tracheostomy (anatomical factors, evidence of potential prolonged bleeding, and PEEP >12 cm H2O).

Early percutaneous dilatational tracheostomy leads to improved outcomes in critically ill medical patients as compared to delayed tracheostomy.