Many patients who have experienced a severe stroke have impaired airway protective reflexes, resulting in prolonged invasive mechanical ventilation. This is the sickest subgroup those who have had stroke, and their historical mortality rates have been as high as 80%. Nonrandomized data and our pilot study suggested that these patients might benefit from an earlier temporary tracheostomy than is typically provided because the procedure facilitates earlier liberation from mechanical ventilation and initiation of rehabilitation activities. The overall long-term satisfaction of survivors of stroke who undergo intensive and prolonged care and their families is also unknown, as is whether the timing of tracheostomy influences their satisfaction with the hospital experience and the results of treatment.
