Tracheostomies can potentially facilitate easier and more successful weaning from the ventilator in patients that are anticipated to require prolonged ventilation. Other benefits include improvements in patient communication, quality of life, and reduced injury to vocal folds. In addition to potential benefits, we discuss complications associated with tracheostomy. Following that is a discussion of the evidence regarding early versus late tracheostomy as well as open versus percutaneous approaches. We then describe and discuss the different percutaneous tracheostomy techniques.