Absolute Contraindications
- Patient Refusal
- Unstable fractures of the cervical spine 1
- Severe local infection of the anterior neck 1
- Uncontrollable coagulopathy 1
Relative Contraindications
- Lack of need:
- Unlikely to survive >48 hours
- Unlikely to require >2 weeks ventilation
- Controlled local infection
- Coagulopathy:
- PT or APTT >1.5
- Platelets <50
- High PEEP (>10) or FiO2 (>0.6) requirements 1
- Difficult anatomy (contraindication to percutaneous tracheostomy, surgical tracheostomy advised):
- Abnormal or prominent vasculature at insertion site 1
- Morbid obesity 1
- Short thick neck 1
- Reduced neck extension 1
- Excessive goiter 1
- Tracheal deviation 1
- Previous radiotherapy 1
- Proximity to extensive burns or surgical wounds 1
- Elevated intracranial pressure 1
- Haemodynamic instability 1