ENT-UK currently recommended performing tracheostomy on or after 14 days of intubation [2], and the British Laryngological Association (BLA) recommend deferring until the patient has a positive end-expiratory pressure (PEEP) requirement of ≤ 10cm H20 and an Fi02 of ≤ 0.4 [3]. As yet, there is no evidence-base beyond expert consensus.