Percutaneous tracheostomy insertion: a national survey of contemporary UK intensive care practice

For over a decade, national guidance and tracheostomy safety organisations have sought to improve the care for patients with tracheostomies, including practice relating to their insertion. Since this guidance there has been no widespread appraisal of insertion practice. An electronic survey was distributed via national organisations to consultant intensivists across the United Kingdom. Questions explored how tracheostomy procedural practice aligns with national guidance and clinical and haematological safety thresholds. Two-hundred and eight responses were obtained between October 2024 and March 2025. Results indicated common use of Local Safety Standards for Invasive Procedures (93%), bronchoscopy (100%) and front-of-neck ultrasound (75%). There was disparity in clinical safety thresholds and contraindications for insertion. Most would not perform a tracheostomy if F_IO₂ was >0.5 (82% of respondents) or positive end expiratory pressure was >10 cmH₂O (65% of respondents). Thresholds of 50 × 10⁹.l^-1 for platelet count and 1.5 for international normalised ratio were common. These findings demonstrate the adoption of recommended techniques to enhance procedural safety during percutaneous tracheostomy insertion (checklists, use of ultrasound and bronchoscopy). There were disparities in safety thresholds, particularly F_IO2 and haematological parameters. Expert guidance, prospective observational work and a national case registry would provide useful information on practice, including complications.