What are the contraindications to tracheostomy?

Absolute Contraindications
  • Patient Refusal
  • Unstable fractures of the cervical spine
  • Severe local infection of the anterior neck
  • Uncontrollable coagulopathy
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
  • Difficult anatomy (contraindication to percutaneous tracheostomy, surgical tracheostomy advised):
    • Abnormal or prominent vasculature at insertion site
    • Morbid obesity
    • Short thick neck
    • Reduced neck extension
    • Excessive goiter
    • Tracheal deviation
    • Previous radiotherapy
    • Proximity to extensive burns or surgical wounds
  • Elevated intracranial pressure
  • Haemodynamic instability