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Respiratory complications remain a major cause of morbidity and mortality in the acute quadriplegic patient population. The literature has suggested that early insertion of a tracheostomy facilitated pulmonary management and an earlier discharge from the intensive care unit (ICU). Recently, a change in practice has meant that these patients are considered for extubation and intensive physiotherapy treatment, including an overnight on‐call service, rather than tracheostomy. The aim of the present retrospective, case‐controlled study was to determine if either practice resulted in a difference in length of stay in intensive care and if an on‐call physiotherapy service for these patients was cost effective.

A case control design was used. Between April 1997 and November 1999, seven patients who did not require a tracheostomy were identified; case control subjects were matched for …