Are the provided criteria the only considerations for bedside tracheostomies (tracheostomies performed at the patient's bedside)?

Bedside Tracheostomy Patient Selection Criteria

Bedside tracheostomy procedures should be performed in a negative-pressure room, preferably in the ICU, with a team consisting of the least number of providers with the highest level of experience to minimize risk of infection transmission and complications. 1

Patient Selection Criteria for Bedside Tracheostomy

Anatomical Considerations

• Normal neck anatomy without significant anatomical abnormalities 1
• Absence of significant pretracheal vessels (should be confirmed by ultrasound) 1
• No excessive obesity that would complicate the procedure 1
• No limitations in neck extension 1

Physiological Considerations

• Hemodynamically stable patients 1
• Adequate oxygenation 1
• Minimal ventilatory requirements 1
• Ability to tolerate the procedure with sedation 2

Location Considerations

• Negative-pressure room availability (preferably in ICU) 2, 1
• If negative pressure rooms are unavailable, a normal pressure room equipped with HEPA filters with strict door policy may be used 2, 1
• Portable HEPA filtration systems can be used if negative pressure is not available 1

Procedural Requirements

Team Requirements

• Experienced operator with adequate assistance 1
• Minimal number of healthcare providers to reduce exposure risk 2
• Enhanced personal protective equipment (PPE) for all team members 2, 1
• Clear communication protocols while wearing PPE 1

Equipment Requirements

• Complete tracheostomy kit at bedside 2, 3
• Functional suctioning system 3
• Oxygen source 3
• Manual resuscitation bag 3
• Waveform capnography (should be immediately available) 2
• Fibreoptic scope (should be immediately available) 2
• Ultrasound guidance (to potentially reduce need for bronchoscopy) 1

Contraindications for Bedside Tracheostomy

• Significant pretracheal vessels identified by ultrasound 1
• Severe hypoxia requiring high oxygen 4
• Uncorrected coagulopathy 5, 4
• Unstable cervical spine injuries requiring special positioning 6
• Anatomical abnormalities that would complicate the procedure 1

Timing Considerations

• Tracheostomy should be considered when the need for prolonged intubation (longer than 14 days) is identified 7
• The decision can generally be made within 7 days of intubation 7
• Daily weaning assessment should be included in the decision-making process 7

Technique Selection

• Both percutaneous dilatational tracheostomy (PDT) and open surgical tracheostomy (OST) can be performed at the bedside 2
• The choice between PDT and OST should be based on institutional expertise and defined protocols 1
• When OST is chosen, it should preferably be performed at the bedside in the ICU 2

Practical Implementation

• Multidisciplinary planning before the procedure is essential 1
• Detailed rehearsal of the procedure and a checklist of equipment and medications can help minimize risks 1
• Complete neuromuscular blockade should be used during the procedure 1
• Packing the oropharynx and performing apnea during high-risk steps can reduce complications 1
• Reducing or avoiding suction and diathermy can minimize infection transmission risk 1

Bedside tracheostomy has been shown to be safe and efficient when these criteria are followed, allowing timely tracheostomy with low morbidity even in high-risk patients 6.