You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
it has advantages compared with translaryngeal endotracheal intubation , including reduced laryngeal anatomical alteration , reduced inspiratory load , and better patient tolerance and ease of nursing .
thus , tracheostomy can enhance patient care in the event of prolonged respiratory support and difficulty in weaning . in the study conducted by arabi and colleagues ,
those investigators examined the frequency with which tracheostomy was conducted ; pathophysiological characteristics of patients undergoing early ( first week in the intensive care unit [ icu ] ) and late tracheostomy ( > 7 days in the icu ) ; and the impact of early tracheostomy on the duration of mechanical ventilation , icu length of stay and outcomes in a selected population of trauma patients .
they reported that the majority of patients underwent tracheostomy after the first week , and that patients who received tracheostomy within the first week had maxillofacial trauma and more severe neurological injuries .
first , the data are from a single population of patients with severe neurological and maxillofacial trauma .
the results presented suggest that early tracheostomy may reduce icu length of stay and resource utilization in severe trauma , which is in accordance with previous data reported in patients with acute respiratory failure , but early tracheostomy did not reduce hospital length of stay or mortality .
a recent study , performed in medical intensive care patients , showed that early percutaneous dilational tracheostomy outweighted the risks of prolonged translaryngeal intubation , leading to reduced mortality , pneumonia , icu stay and duration of mechanical ventilation there is general agreement that tracheal intubation should be the first approach , and only thereafter is evaluation for possible tracheostomy necessary .
in particular , it has been recommended that translaryngeal intubation be done in those patients whose anticipated need is up to 10 days , and that tracheostomy be done if an artificial airway is likely to be required for longer than 21 days .
tracheostomy is mandatory in severe maxillofacial or neck trauma , burns to the head , neck and airways , and presence of altered swallowing ( in which case early tracheostomy is needed ) . on the other hand ,
tracheostomy is indicated for prolonged respiratory support and airway maintenance in order to prevent complications of long - term translaryngeal intubation in chronic myopathies or laryngeal cord paralysis ( late tracheostomy ) .
regardless , the decision on the timing of tracheostomy should be made on an individual basis , taking into account the patient 's age and prognosis . in the study conducted by arabi and colleagues ,
surgical tracheostomy is mandatory , particularly in the presence of anatomical or pathological alterations to the neck .
the percutaneous dilatation technique was proposed by ciaglia and coworkers   in 1985 , and since then other methods have been proposed so that percutaneous tracheostomy may be performed at the bedside , rather than surgical tracheostomy in the operating theatre [ 7 - 10 ] .
various complications have been reported for percutaneous techniques , including tracheal ring fracture or dislocation , tracheal stenosis and obliteration above the tracheostoma , emphysema or pneumothorax due to posterior tracheal wall laceration , tracheo - oesophageal fistola , and acute fatal haemorrhage .
several studies have compared safety and outcome with percutaneous tracheostomy versus those with surgical tracheostomy , but lack of rigorous design renders useful comparisons quite impossible .
the majority of prospective randomized trials reported that potential advantages of percutaneous technique relative to surgical tracheostomy include ease of performance , and lower incidence of peristomal bleeding and postoperative infection , which are associated with lower costs [ 12 - 14 ] . among the percutaneous techniques , the most popular are the modified original ciaglia technique ( ' single step ' blue rhino ) , the guidewire dilator forceps technique proposed by griggs and coworkers , the percu - twist technique proposed by frova and quintel , and the translaryngeal technique proposed by fantoni and ripamonti .
the blue rhino , the griggs and the percu - twist techniques are characterized by dilation of the tissues using forces applied from outside to inside the tracheal wall ( intrusive techniques ) .
the main potential complications with these techniques are rupture or dislocation of tracheal rings and bleeding .
the main advantages are that ventilation is relatively easy during the manoeuvre and the neck does not need to be overdistended .
the translaryngeal technique is different from the others becouse the cannula is stripped from inside to outside ( extrusive technique ) .
thus , the translaryngeal technique is indicated in patients with active spontaneous bleeding or in patients at high risk for bleeding , such as those receiving heparin therapy or with coagulation factor deficits . moreover ,
this technique is first choice in paediatric patients , in whom other techniques are contraindicated .
the main problem with this technique is its complexity because of the need for two intubations .
thus , the technique is contraindicated in patients with expected difficult intubation and in those in whom extension of the neck must be avoided .
regardless of technique , it has been suggested that bronchoscopy should be used when performing percutaneous tracheostomy , with simple or video - assisted endoscopy , to facilitate and reduce possible complications .
few studies in small groups of patients have been performed , and so there are few data with which to compare different percutaneous techniques [ 16 - 18 ] . in general , it does not appear that any one percutaneous technique is better than any other , but the patient 's choice and the experience of the operator are determining factors .
it is important to emphasize that the introduction of different percutaneous techniques has reduced the number of supposed contraindications to tracheostomy in selected patients . in cardiothoracic patients , with mediastinal wounds , the percutaneous techniques
should be considered first choice because of the marked reduction in tracheostomy - associated risk for mediastinitis .
tracheostomy in these patients has also been reported to be effective in reducing the duration of mechanical ventilation and in expediting weaning . in head trauma and neurological patients , who are at high risk for nosocomial infection ,
the percutaneous tracheostomy was found to be associated with a marked reduction in late infections of the stoma . in severe head injury patients , however , careful monitoring of the physiology of the brain should be done , adequate sedation given , and timing carefully considered .
tracheostomy should be performed as soon as a stable physiological condition in the brain is achieved and prolonged ventilation is expected . however , in spine injured patients we believe that blue rhino , griggs and percu - twist techniques are preferable because of the reduced need to extend the neck to optimize the manoeuvre . in patients with coagulation problems , percutaneous techniques , and in particular the translaryngeal technique , are indicated . in patients with severe respiratory failure percutaneous techniques
have been found to be safe , but it is wise to perform tracheostomy only when respiratory insufficiency is stabilized .
development of the griggs technique has broadened the indications for tracheostomy to include emergency settings , whereas the translaryngeal technique is contraindicated .
it is also important to emphasize that , after the procedure has been completed , careful clinical monitoring of the patient is mandatory , as well as bronchoscopy to clear airway secretions and blood , and to confirm correct positioning of the tracheostomic tube and so avoid bronchial intubation . in conclusion , tracheostomy can offer several advantages in the management of critically ill patients who need mechanical ventilation and/or airway control .
the optimal timing of tracheostomy remains controversial , but it appears that early tracheostomy in selected patients , such as those with severe trauma , burns and neurological injuries , may be effective in reducing the duration of mechanical ventilation , icu stay and costs .
percutaneous tracheostomy techniques are becoming the procedures of choice in the majority of cases because they are safe , easy and quick , and complications are minor .
however , percutaneous tracheostomies should always be performed by experienced physicians so that unnecessary additional complications may be avoided .
it is not clear whether any one percutaneous technique is superior to any other , but experience of the operator and the anatomical and physiopathological characteristics of the patient should always be considered .
the operator should have experience of at least one intrusive and one extrusive percutaneous technique .
in general , the ' optimal ' tracheostomy does not exist ; we must use the right technique in the right patient and at the right time .
tracheostomy is one of the most frequent procedures carried out in critically ill patients with major advantages compared to translaryngeal endotracheal intubation such as reduced laryngeal anatomical alterations , reduced inspiratory load , better patient 's tolerance and nursing . 
 thus , tracheostomy can enhance patient 's care in patients who need prolonged mechanical ventilation and/or control of airways . 
 the right timing of tracheostomy remains controversial , however it appears that early tracheostomy in selected severe trauma , burn and neurological patients could be effective to reduce the duration of mechanical ventilation intensive care stay and costs . 
 percutaneous tracheostomy techniques are becoming the procedure of choice in the majority of the cases , since they are safe , easy and quick , and complications are minor . 
 however , percutaneous tracheostomies should be always performed by experienced physicians to avoid unnecessary additional complications . 
 it is not clear the superiority of one percutaneous technique compared to another , but experience of the operator and clinical individual anatomical , physiopathological characteristics of the patient should be always considered . 
 we believe that the operator should have experience of at least one intrusive and one extrusive percutaneous technique . 
 the general " optimal " tracheostomy technique and timing do not exist , but tracheostomy should be targeted on the patient 's individual clinical characteristics .