Tracheostomy is one of the oldest surgical procedures and its technique has evolved over time. Nearly half of all tracheostomies are performed in the ICU. Most of these tracheostomies are temporary. Percutaneous dilatational tracheostomy (PDT) has become a standard practice in intensive care unit (ICU). However, many aspects of its practice are not yet clear. This bedside procedure when performed by experienced intensivists is reasonably safe but has known complications. In this review, the basics of tracheostomy, indications, contraindications, various techniques, complications, the assisting aids for PDT and the operator competence required are discussed. Finally PDT is compared with surgical tracheostomy and the feasibility of PDT in patients with coagulopathy, obesity and on high PEEP is reviewed.
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