When is early vs late tracheostomy indicated?

TracMAn trial: early (1-4 days) vs late (>10 days) tracheostomy showed no mortality difference in mixed ICU population; early tracheostomy may benefit TBI and neurological patients by reducing sedation and ICU stay; neurosurgery and trauma patients benefit most from early.

What are the clinical criteria for tracheostomy consideration?

After 7-10 days of mechanical ventilation when: prolonged ventilation likely, airway protection required, facilitation of weaning, secretion management needed, or neurological injury with uncertain airway recovery; never for patient convenience alone.

What is the tracheostomy cuff deflation readiness assessment?

Cuff can be deflated trial when: secretions manageable, patient can tolerate PAP 0, SpO2 maintained on FiO2 <0.40; speaking valve (Passy-Muir) placed after successful cuff deflation; required for voice and swallowing rehabilitation.

What is the decannulation protocol for tracheostomy?

Step 1: pass cuff-deflated trial; Step 2: speaking valve tolerance >4h; Step 3: downsizing tracheostomy tube; Step 4: tracheostomy occlusion 24h trial; Step 5: decannulation; SLP assessment for dysphagia/aspiration throughout.

What bedside tests assess decannulation readiness?

RSBI 60 L/min; secretion volume manageable; no high-flow O2 requirement; FEES/MBSS to assess aspiration risk; patient alert enough to cooperate with occlusion trial.

TracMan Tracheostomy Timing Assessment and ICU Protocol

Assesses tracheostomy candidacy and optimal timing using ICU-TracMAn criteria, Passy-Muir valve readiness, and decannulation protocol milestones for mechanically ventilated patients.

Weight

Height

Clinical Guidance

BMI is a screening measure of body size, not a direct measure of body fat. The standard WHO categories are underweight (<18.5), normal (18.5–24.9), overweight (25–29.9), and obese (≥30).

BMI can overestimate body fat in athletes with high muscle mass and underestimate it in older adults with low muscle mass. Interpret it alongside waist circumference and clinical context rather than as a standalone diagnosis.

⚕ Clinical Disclaimer: These calculators are for educational and reference purposes only. Always verify results with qualified clinical judgment and current clinical guidelines. Do not use as a sole basis for medical decisions.

How It Works

Assesses tracheostomy candidacy and optimal timing using ICU-TracMAn criteria, Passy-Muir valve readiness, and decannulation protocol milestones for mechanically ventilated patients

Each component has a specific meaning:

ICU-TracMAn criteria — The icu-tracman criteria recorded for the patient or scenario being assessed.
Passy-Muir valve readiness — The passy-muir valve readiness recorded for the patient or scenario being assessed.
Decannulation protocol milestones — The decannulation protocol milestones recorded for the patient or scenario being assessed.

Note: Interpret the tracheostomy timing result against the clinical thresholds and context described above.

How to Use

Enter the ICU-TracMAn criteria, Passy-Muir valve readiness, decannulation protocol milestones for the patient or scenario you are assessing. Assesses tracheostomy candidacy and optimal timing using ICU-TracMAn criteria, Passy-Muir valve readiness, and decannulation protocol milestones for mechanically ventilated patients. Use the tracheostomy timing result to inform your clinical assessment.

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