Definition of Prolonged Intubation
Prolonged intubation is most commonly defined as endotracheal tube placement exceeding 10-15 days, though some literature uses thresholds ranging from 7 days to 2-3 weeks. 1, 2
Standard Definitions in Clinical Practice
The definition varies across clinical contexts and guidelines:
10-15 days: The American Thoracic Society recommends considering tracheostomy when mechanical ventilation is anticipated to exceed 10-15 days, effectively defining this timeframe as "prolonged" intubation 1
14-21 days: The American Academy of Otolaryngology-Head and Neck Surgery recommends early intervention and consideration of tracheostomy after 14-21 days to minimize long-term morbidity and mortality from laryngotracheal complications 2
7 days or more: Historically, many healthcare centers have defined prolonged intubation as exceeding seven days 3
More than 48 hours: In the context of physiotherapy interventions, mechanical ventilation for more than 48 hours is considered sufficient duration to warrant specific weaning protocols 4
Clinical Significance of Duration
The timeframe matters because laryngotracheal injury begins early and increases with duration:
After 4 days: Direct laryngoscopy shows that 94% of patients develop laryngeal injury, including edema and ulceration of the posterior and medial vocal folds 2
Within 4 weeks post-extubation: Up to 44% of patients with prolonged intubation develop vocal fold granulomas 2
Beyond 2 weeks: Patients can undergo translaryngeal intubation for up to 2 weeks without significantly increasing complications relative to transtracheal intubation, though this varies by patient population 5
Practical Clinical Threshold
For clinical decision-making regarding tracheostomy, the 10-15 day threshold is most widely accepted and evidence-based 1. This timeframe balances the risks of continued endotracheal intubation against the risks of tracheostomy, and represents the point at which tracheostomy offers clear advantages including more ventilator-free days, shorter ICU stays, and lower incidence of ventilator-associated pneumonia 1.
Important Caveats
High-risk patients (diabetics, those with ischemic disease, rigid-posture head-injured patients) may warrant earlier tracheostomy consideration due to increased risk of laryngeal injury 2, 5, 6
The definition is context-dependent: what constitutes "prolonged" for research purposes (often >48 hours for weaning studies) differs from surgical decision-making thresholds (typically 10-21 days) 4, 1, 2
Aggressive cuff over-inflation during the COVID-19 pandemic has heightened concerns about complications even with shorter intubation durations 4, 2