This guideline does not cover emergency tracheostomies.
A planned tracheostomy should be performed by medical practitioners who have been trained, and are competent in the procedure, or are under direct senior bedside supervision.
The minimum staffing required is 2 trained medical practitioners plus a third member of staff to assist.
All Critical Care Areas should have their own Difficult Airway trolley.
Endoscopy should be readily available and its routine use is likely to improve the safety of insertion procedures and management of airway problems thereafter.
A recent NCEPOD study has confirmed a relatively low frequency of serious periprocedural complications in ICU patients receiving a tracheostomy.
Tracheostomy wherever performed is a surgical procedure. As highlighted in the recent NCEPOD report; practices would be improved by national data collection of tracheostomy and other airway procedures, introduction of WHO style preoperative checklists and more consistent consent procedures.
