Figure 1: Our current intramural protocol for tracheostomy is shown. Sequential indispensable decisions and events are shown in order from the top to the bottom in the left columns. The multidisciplinary team consists of attending physicians, airway surgeons (mainly otolaryngologists in our institution), anesthesiologists, and nurses. The roles and responsibilities of each participant are clarified for each step. If necessary, anesthesiologists are invited to join the discussion to decide the necessity of the tracheostomy for the patient. Once the tracheostomy performance is decided, it is mandatory for the airway surgeons to notify the anesthesiologists of the tracheostomy performance. At this point, anesthesiologists join the team as critical care specialists. Circle, Member(s) to take the responsibility for each step; Filled circle, Member(s) to back up the responsible member(s) at each step; Triangle, Member(s) to join the discussion as needed. IC: Informed consent; ICU: Intensive care unit; OR: Operating room.