Each year in the US, more than 5 million adults present with critical illness requiring intensive respiratory support.1 Nearly 1 in 50 of those adults will require a tracheostomy as an integral component of their initial care.2 In modern US medicine, the widespread adoption of percutaneous tracheotomy technique coupled with a push for rapid transition from acute care to longer-term recovery destinations has altered where, when, and who performs tracheotomy in patients with critical illnesses with cardiopulmonary failure.