Critical Care Medicine continues to address the needs of critically ill patients on multiple levels. Recent advances in surgical technology have suggested that bedside percutaneous tracheostomy (PCT) is beneficial for patients who will require mechanical ventilation for prolonged periods. Cost and staff manpower is decreased. Patient comfort is enhanced, decreasing sedation requirements, the efficiency of pulmonary toilet is increased, possibly decreasing the advent of Ventilator Associated Pneumonia (VAP) and facilitation of weaning from the ventilator by allowing rapid resumption of mechanical ventilation if the attempt unexpectedly fails.

On April 14, 2008, David Crippen, MD, Associate Professor in the Department of Critical Care Medicine presented the first of what is to become a yearly multi-disciplinary training course on PCT for the second year adult critical care fellows. The faculty included both surgeons and experienced critical care physicians.

The didactic portion of the course included the history of tracheostomy, review of the anatomy of the neck and upper thorax, review of the different styles and techniques for tracheostomy available, open vs. closed techniques (including videos), timing of tracheostomy, benefit to the patient from PCT, financial benefits to the hospital for performing percutaneous tracheostomy under DRG and review of the possible complications from tracheostomy.

The practical portion of the course included hands-on placement of percutaneous tracheostomy utilizing cadavers. On completion of the course, the students received a certificate stating that they were exposed to the principles and practice of percutaneous tracheostomy. This will not be a certificate of competency but it will serve as the first platform to continue their training toward certification.

The performance of PCT is now firmly within the realm of the critical care physician. Accordingly, hands-on training of the procedure for critical care trainees is mandatory.