ICU days are costly. In the typical scenario, a patient in the ICU is identified as requiring a feeding tube. Once identified, the service performing the procedure must be consulted and the procedure scheduled. Coincidentally, it is not uncommon for the same patient to require a tracheostomy. Again, the service performing the procedure must be consulted and the procedure scheduled. These two procedures are most often performed separately, requiring different occurrences of anesthesia, different teams of physicians and staff, and perhaps even different locations of service. Coordinating these efforts, even in the most efficient settings, is a challenge. Awaiting or delaying either procedure often leads to longer ICU or hospital stays. Each day extra in an ICU is expensive, even more so if using mechanical ventilation.