Tracheotomy in mechanically ventilated critically ill patients is a procedure commonly performed in the intensive care unit. The aim is to facilitate respiratory weaning and improve clinical outcome by reducing side effects of prolonged invasive mechanical ventilation and sedation. At the same time, the risk of tracheotomy associated complications must be minimized. Indications, method and timing must be individualized for each patient. Main determinants for decision-making, success and safety are the expected individual clinical benefits, the patient risk factors for complications and aspects of local experience and logistics. This review summarizes current concepts and evidence.
