Why Pope John Paul II received a tracheostomy

As you have heard, the Pope underwent a tracheotomy for respiratory distress. It was stressed by the Vatican that it was not done as an emergency measure. Just to clarify, the procedure where the hole is being created is called a tracheotomy, while the hole itself is called a tracheostomy.

From UptoDate, here are some advantages and disadvantages between the tracheostomy and intubation for mechanical ventilation:

Why was the tracheostomy done so early in hospitalization? One study compared early (less than 48 hours) versus late tracheostomy in respiratory failure:

Early group showed significantly less mortality (31.7% vs. 61.7%), pneumonia (5% vs. 25%), and accidental extubations compared with the prolonged translaryngeal group (0 vs. 6). The early tracheotomy group spent less time in the intensive care unit (4.8 +/- 1.4 vs. 16.2 +/- 3.8 days) and on mechanical ventilation (7.6 +/- 2.0 vs. 17.4 +/- 5.3 days). There was also significantly more damage to mouth and larynx in the prolonged translaryngeal intubation group.

At what point would the tracheostomy be reversed? First, mechanical ventilation would have to be weaned (i.e. the pneumonia would have to resolve to such a point where the Pope can breathe on his own). UptoDate lists the other conditions that are required before the tracheostomy is reversed:

* No upper airway obstruction.
* The ability to clear secretions which are neither too copious nor too thick.
* The presence of an effective cough.

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