Therein lies the rub. Studies involving tracheostomy often employ different design methods and patient groups, and are challenging to compare. As in the current study, tracheostomy practices are often self-reported rather than obtained from prospectively recorded databases, giving rise to a potential source of error. Although the decision to perform a tracheostomy is complex, it can be broken down into two simple questions concerning a calculation of the likely benefit for any individual patient and an estimate of the duration of mechanical ventilation.5 The different complications of translaryngeal intubation vs tracheostomy have been reviewed elsewhere in detail. Likewise, the potential advantages of tracheostomy, such as increased comfort, enhanced oral nutrition, and ease of ventilator weaning, have been extensively studied and will not be reiterated here.5 Nevertheless, objective proof of these potential advantages remains difficult to obtain.