Percutaneous dilatational tracheostomy is generally not recommended for achieving emergency airway control or access. Endotracheal intubation or cricothyrotomy is the most appropriate emergency technique to achieve adequate airway control and ventilation. Percutaneous dilatational tracheostomy is a safe and appropriate technique for use in the intubated patient who requires elective tracheostomy. It may be done at the bedside in the intensive care unit.

Contraindications to percutaneous dilatational tracheostomy include the following:

Appropriate positioning and preparation of the patient are essential to achieving good operative results. Therefore, in both techniques, the following preparations must be made. Place the intubated patient in a supine position. Continuous monitoring should include electrocardiographic monitoring of heart rate, blood pressure, pulse oximetry, inspired title volume, and ventilator pressures. Increase the inspired oxygen fraction to 100% and ensure adequate ventilation. Because a firm operating surface is necessary, place a cardiopulmonary resuscitation board under the patient’s upper torso. Extend the cervical spine by placing a rolled towel between the shoulder blades (see Fig. 4-1A). Prep and drape the anterior neck with sterile towels.