O_S, you've got many years on me... but when I worked in an ICU and a patient is as you described, not likely to recover, talking about withdrawl of treatment usually happened before the trach. Oral intubation like you said is a week, 10 days max but I've seen it much, much longer than that! Trachs are fine for people with a fighting chance. But in the elderly and in hopless cases, it's sad when a family isnt able to accept the inevitable and prolongs death by invasive means. Yes, you can downgrade them and clear an ICU bed, but where are you going to send them? In this area we have ventilator dependent hospitals, I've never worked in one, but have been told by respiratory therapists that they are the saddist places to be. Patients are trached by the good intentions of staff and family then left in the hospital, by themselves with few visitors for years. Sorry, this turned into a rant....