Percutaneous tracheostomy has become an established procedure in airway management of critically ill patients. It offers advantages over prolonged tracheal intubation and conventional tracheotomy. Nowadays six different techniques are available in Germany, all of which are based on Seldinger's technique. Even though these techniques are technically simple and the complication rates low, specific indications for the conventional surgical technique remain. It must be noted further that despite its minimally invasive nature percutaneous tracheostomy is still a surgical manipulation on the airway of a critically ill patient. Immediate recognition and adequate treatment of any complications are of primary importance. To reduce airway complications bronchoscopic surveillance is absolutely necessary.