Tracheotomy was initially described as a means to relieve acute upper airway obstruction. Indications for its use have changed and developed over time.During the 1960's, tracheotomy was promoted as a treatment for ventilator-dependent patients but the complications reported in the 1970's and early 1980's both reduced its accepted indications and led to it being proposed later. During the last 20 years advances in intensive care medicine and a reduction in the rate of complications associated with the procedure have encouraged intensivists again to propose tracheotomy at an earlier stage.Over the last 10 years, a new technique, percutaneous dilatational tracheotomy has gained widespread acceptance because of its simplicity of execution, its low cost and the low rate of postoperative complications that has been observed.Although the ideal time to perform a tracheotomy has not yet been established, the benefits of this approach compared to prolonged laryngeal intubation, the low morbidity associated with modern surgical tracheotomy and the development of percutaneous techniques support the use of this procedure in the management of patients requiring prolonged ventilatory support.