Indication, timing and technique of tracheostomy in intensive care medicine have changed significantly during the last decade. Benefits and risks of percutaneous dilatational tracheostomy are reviewed in the current literature. Typical complications are misplacement of the tracheal cannula, injury to the trachea, trachealstenosis, rupture of the cuff-ballon and death. The results of a questionnaire about the use, timing and complications of percutaneous dilatational tracheostomy at 651 German intensive care units are presented. In Germany tracheostomy is performed within 20 days in 75% of patients on mechanical ventilation, following the recommendation of the Consensus Conference on Artificial Airways in Patients Receiving Mechanical Ventilation from 1989. Percutaneous dilatational tracheostomy in Germany is performed following the methods described by Ciaglia in 58% of intensive care units, Griggs in 35% and Fantoni in 7%.