| Design | UK multicentre RCT, n=909 across 70 ICUs |
| Published | 2013 (JAMA) |
| Result | No difference in 30-day mortality between early tracheostomy (~day 4) and late tracheostomy (~day 10) in mechanically ventilated patients (30.8% vs 31.5%). Many late-group patients never required tracheostomy. |
| Practice impact | Did not support routine early tracheostomy. A selective, later approach is acceptable and avoids unnecessary procedures. |
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