Percutaneous tracheotomy (PT) is beneficial in decreasing dead space and reducing airway resistance when compared with intubation. Absolute contraindications include the need for an emergent airway or inability to intubate the patient. All current PT methods are based upon the Seldinger technique of dilators placed over a guidewire. It is recommended that PT be performed under simultaneous video bronchoscopy. Techinques for PT are: Ciaglia method (percutaneous dilating technique), Griggs technique (guidewire dilating forceps (GWDF) technique), Fantoni's technique (translaryngeal approach), and PercTwist (screw-action dilator). Two important issues specific to PT that may arise during the course of the procedure are accidental penetration of the endotracheal tube cuff with the introducer needle during initial puncture of the anterior tracheal wall and possible dislocation of the endotracheal tube. The most common immediate postoperative complication is bleeding. Long-term complications have been reported extensively in a number of studies and metaanalyses.