Percutaneous dilatational tracheostomy in critical illness: A practice survey of intensivists in Australia and New Zealand

Objective To describe current percutaneous dilatational tracheostomy (PDT) practice across Australian and New Zealand (ANZ) intensive care units (ICUs), quantify perceived procedural exposure among intensivists and trainees, and evaluate perceptions of competency and training adequacy. Design Cross-sectional, anonymous, online survey of 11–16 questions, depending on clinical role, investigating: frequency of PDT, demographics of respondents, their experience in performing and supervising PDT in 2024 and their opinion about processes for training and maintaining procedural competency. Setting ANZ ICUs. Participants College of Intensive Care Medicine trainees and specialists. Results Of 321 respondents, 270 complete individual survey responses were analysed. Data from 23 ICUs indicated a median PDT rate of 0.41% (interquartile range [IQR]: 0.20–0.96%) of ICU admissions. Most clinicians performed two (IQR: 0–3) PDTs in 2024 and supervised a further two (IQR: 0–3). While most specialists felt confident performing or supervising PDT, fewer believed they performed enough to maintain competency, and many reported insufficient trainee opportunities. Procedural exposure was unevenly distributed: consultants performed significantly more PDTs than trainees (median [IQR]: 2 [1–3] vs. 1 [0–2]; p = 0.004) yet only five respondents recalled procedural frequency that would have met published annual thresholds (based on expert opinion) for maintaining competency. 1 Free-text analysis identified four themes: declining volume of practice; concerns about skill fade and limited trainee exposure; support for supplemental training activities; and uncertainty over whether PDT should remain a universal ICU competency. Conclusions PDT is now a low-volume and variably performed procedure across ANZ ICUs. Survey respondents reported that this is affecting training and maintenance of competency.