Inclusion Criteria

1. Patient on ICU less than 4 days (96hrs)
2. Patient intubated with endotracheal tube
3. High chance patient will require 7 days or more of ventilatory support during their ICU stay
4. Consultant ‘uncertain’ about whether “early” or “late” traheostomy is more appropriate for this patient
5. Facilities are available to carry out the tracheostomy within the 1 to 4 day time frame (if patient is randomised to “early” group)
6. Informed consent/consultee agreement obtained