Concomitant Bedside Percutaneous Tracheostomy and Ultrasound Gastrostomy

Exclusion Criteria

• •History of prior gastrostomy, tracheostomy, laryngectomy, gastrostomy prior to tracheostomy decision, known head and neck and gastrointestinal abnormality (cancer, congenital abnormality, anatomic variants).
• •Hospitalization \> 21 days at the time of screening
• •Known social discharge issues that in the opinion of the investigator will substantially impact the LOS.
• •Participants with non-survivable injuries or disease, anticipated life expectancy \< 30 days.
• •Uncontrolled coagulopathy
• •Contraindications for percutaneous gastrostomy procedures
• •Severe Ascites
• •Abdominal wall infection at selected site of procedure
• •Severe gastroparesis
• •Gastric outlet obstruction
• •Absolute contraindications to percutaneous dilatational tracheostomy procedure
• •Cervical instability
• •Infection at the planned insertion site
• •Relative contraindications to percutaneous dilatational tracheostomy deemed present by the clinical team
• •Difficult anatomy (e.g., short neck, morbid obesity, minimal next extension, or tracheal deviation)
• •Severe respiratory disease resulting in inability to withstand periods of apnea or in the loss of positive pressure ventilation
• •Pregnancy
• •Incongruent goals of care between care team and LAR (family representative).
• •Other procedure related concerns by the primary team that would affect safety of the patient.