Concomitant Bedside Percutaneous Tracheostomy and Ultrasound Gastrostomy

Inclusion Criteria: * Informed consent must be obtained from the participant or a Legally Authorized Representative before any trial-specific assessment is performed * Male or female ≥ 18 years of age * Participants with Ventilator Dependent Respiratory Failure (VDRF) * Indication for a bedside percutaneous tracheostomy procedure using an FDA approved percutaneous dilatational tracheostomy device * Indication for percutaneous gastrostomy including Percutaneous Ultrasound (PUG), Percutaneous Radiologic (PRG), and Percutaneous Endoscopic Gastrostomy (PEG) using an FDA approved gastrostomy kit * No contraindications to bedside percutaneous tracheostomy OR gastrostomy * Women of childbearing potential must have negative serum or urine pregnancy test during the current hospitalization Exclusion Criteria: * History of prior gastrostomy, tracheostomy, laryngectomy, gastrostomy prior to tracheostomy decision, known head and neck and gastrointestinal abnormality (cancer, congenital abnormality, anatomic variants). * Hospitalization \> 21 days at the time of screening * Known social discharge issues that in the opinion of the investigator will substantially impact the LOS. * Participants with non-survivable injuries or disease, anticipated life expectancy \< 30 days. * Uncontrolled coagulopathy * Contraindications for percutaneous gastrostomy procedures * Severe Ascites * Abdominal wall infection at selected site of procedure * Severe gastroparesis * Gastric outlet obstruction * Absolute contraindications to percutaneous dilatational tracheostomy procedure * Cervical instability * Infection at the planned insertion site * Relative contraindications to percutaneous dilatational tracheostomy deemed present by the clinical team * Difficult anatomy (e.g., short neck, morbid obesity, minimal next extension, or tracheal deviation) * Severe respiratory disease resulting in inability to withstand periods of apnea or in the loss of positive pressure ventilation * Pregnancy * Incongruent goals of care between care team and LAR (family representative). * Other procedure related concerns by the primary team that would affect safety of the patient.