Objectives: To provide evidence-based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research.

Methods: A taskforce composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system.

Results: The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified, of which 226 publications were chosen. The taskforce generated a total of 19 recommendations, 10 positive (1B, 3; 2C, 3; 2D, 4) and 9 negative (1B, 8; 2C, 1). A recommendation was not possible in 6 questions.

Conclusions: Percutaneous techniques are associated with a lower risk of infections compared with surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.

目的：为危重成人患者的气管造口术提供基于证据的指南，并确定需要进一步研究的领域。

方法：由泛美和伊比利亚危重症和重症治疗医学学会联合会以及拉丁美洲危重症试验研究者网络的10个成员国的代表组成的工作组根据建议评估、开发和评估系统的分级制定了建议。

结果：该小组在最初确定的87个问题中确定了23个相关问题。在初次检索中，识别出333篇相关出版物，其中选择了226篇出版物。工作组共生成了19个建议，10个为阳性 (1B，3；2C，3；2D，4)，9个为阴性 (1B，8；2C，1)。在6个问题中不可能提出建议。

结论：与外科气管造口术相比，经皮技术的感染风险较低。早期气管造口术似乎仅能减少呼吸机使用的持续时间，但不能减少肺炎的发生率、住院时间或长期死亡率。证据不支持在手术过程中使用常规支气管镜引导或喉罩。最后，与所用技术相比，适当的既往培训在减少并发症方面同样重要，甚至是更重要的因素。