ABSTRACT
Intubation and prolonged mechanical ventilation are associated with morbidity, including vocal granulomas and ulceration of the true cords, in more than half of patients intubated for more than 24 h7. Early tracheal lesions may progress to a circumferential fibrous stenosis that is difficult to later repair. Roughly 20% of patients who survive their ICU stay, and 95% of those dying while intubated, will have significant tracheal lesions8. Functional concerns also favor removing the endotracheal tube as early as possible to avert epithelial damage, loss of cilia, and impairment of tracheal mucous clearance 9. Endotracheal intubation increases the risk of nosocomial pneumonia and often precludes oral feeding, mandating the use of enteral or parenteral nutrition. Iatro -genic malnutrition is thus common in the ventilated patient10. Finally, mechanical ventilation elicits an inflammatory response that can be attenuated by minimizing overdistention of the lung11.
