Bedside percutaneous tracheostomy and gastrostomy tube placement are cost-effective and safe techniques employed in the management of critically ill patients requiring prolonged mechanical ventilation. Both procedures have been well characterized and studied in the surgical and gastroenterology literature. Recently the performance of these procedures by interventional pulmonologists have been reported. This review focuses on the role of the interventional pulmonologist in the ICU, specifically in regard to the placement of percutaneous tracheostomies and gastrostomy tubes. We will discuss the techniques available and the relevant background data regarding choice of method and its integration into clinical practice. In addition, we discuss the creation of a multidisciplinary tracheostomy care team, its effect on patient care, hospital finances, and the interventional pulmonologists role.
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