Percutaneous dilatational tracheostomy is a simple bedside procedure and can be performed with a minimum of time and staff. Tears in the posterior wall of the trachea and paratracheal displacement of the tube are possible complications. These complications can be avoided by performing the procedure under bronchoscopic control. We report on 14 dilatational tracheostomies using this new technique. As a severe complication we noted bleeding from a vein with lethal blood aspiration in one case. Bleeding during dilatational tracheostomy procedure requires changing of technique and dissection of the anterior wall of the trachea.