I think tracheostomy would be advisable to replace natural ventilation only if she presents with signs of respiratory distress and not just to prevent respiratory distress or to increase cerebral oxygen uptake. Nevertheless, I would recommend the administration of molecules such as SOMAZINA to increase cerebral oxygen uptake in this patient.

And keep the patient in a lateral positon rather supine/on her back.

Hi, the principal inspiratory muscle is diaphragm, the intercostal muscles can be classified as principal or accessory depending on the author. I think your question is related more to an strategy to wean your patient from mechanical ventilation than the role of intercostal muscles. If that is what you want to know, i asume that your patient has a orotracheal tube, so the use of a tracheostomy is correct because is indicated for patients on prolonged mechanical ventilation and to facilitate weaning. 

Article Tracheostomy: Why, When, And How?

The answer is yes as it helps to wean the patient from ventilator and better bronchial toilette in expert hands.

Definitely, tracheostomy is better for weaning and reduce infection with good oral hygiene, but no difference in mortality and morbidity!

The benefit also in decrease ICU stay therefore reduce overall cost.

Dear Dr fernandez

I think Currently, tracheotomy is the best way to help this patient.

 in this particular sceinario percutaneous tracheostmy will be right answer. this patient as somebody has already mentioned must be needing mechanical ventilation and will need it for pretty long time .You can always get benefits of right time tracheostomy in such cases.RE intercostal muscle weakness this patient will need tracheostomy for early weaning and preventing resp infections with good tracheal toilette.