Percutaneous dilatational tracheostomy (PDT) should be performed with flexible bronchoscopy guidance to visualize the anterior entry site of the needle, to avoid posterior tracheal injury, and to ensure that the guide wire and dilator are advanced distally. Percutaneous dilatational tracheostomy (PDT) should be performed with flexible bronchoscopy guidance to visualize the anterior entry site of the needle, to avoid posterior tracheal injury, and to ensure that the guide wire and dilator are advanced distally. The single graded dilator technique is optimal. Advantages of PDT include (1) time required for bedside PDT is shorter than for open tracheostomy, (2) elimination of scheduling difficulty associated with operating room and anesthesiology for ICU patients, (3) PDT expedites performance of the procedure because critically ill patients who would require intensive monitoring to and from the operating room need not be transported; and (4) cost of performing PDT is roughly half that of open surgical tracheostomy due to the savings in operating room charges and anesthesiology fees. A: From Reference 73, with permission. B: From Reference 74. Nora H Cheung, and Lena M Napolitano Respir Care 2014;59:895-919 (c) 2012 by Daedalus Enterprises, Inc.