Clinical Research Directory

Inclusion Criteria: * Patients aged ≥10 years. * Isolated traumatic head injury (blunt or penetrating), or traumatic head injury associated with other trauma. * Expected to require invasive mechanical ventilation for at least 72 hours, as judged by the treating intensivist or neurosurgeon. * Endotracheal intubation performed during the current hospital admission. * Enrollment within 48 hours of ICU admission. Exclusion Criteria: * Prior tracheostomy during the same hospital admission. * Irreversible brain injury with anticipated withdrawal of life-sustaining treatment within 72 hours. * Uncorrectable coagulopathy precluding tracheostomy, including platelet count \<50 × 10\^9/L despite transfusion or INR \>1.8 despite correction. * Uncontrolled intracranial hypertension prohibiting safe positioning for tracheostomy despite optimal management. * High cervical spine instability contraindicating positioning for tracheostomy, based on neurosurgical assessment. * Known pregnancy. * Enrollment in a conflicting interventional trial. * Prisoners or other vulnerable groups as defined by local regulations.