Recommendation: We suggest against early tracheostomy in adult patients with ARDS. (GRADE 2C, Strength of recommendation “weak recommendation” / Quality of evidence: ”low”)

● Supplementary conditions: Early tracheostomy could be beneficial in some patients including those anticipated to have prolonged upper airway obstruction, patients with hemodynamic instability due to sedative-analgesic agents required during intubation, and patients with delayed rehabilitation. However, early tracheostomy cannot be recommended for all patients.