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Is there an ideal time to place a tracheostomy? What factors might influence my decision to proceed with an open versus percutaneous tracheostomy? In this episode, we discuss common perioperative considerations influencing our decision to proceed with tracheostomy in critically ill patients requiring prolonged mechanical ventilation. Over the course of rounds, I'll share with you some "tricks of the trade" and review key management principles for safely dealing with potentially life-threatening tracheostomy complications in the postoperative period including unplanned early decannulation and bleeding.