Other than patient refusal give 8 contraindications to performing a percutaneous tracheostomy on the intensive care unit?

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