Nowadays, most patients tolerate short-term trans-laryngeal tracheal intubation with few, if any, complications. For those who require more prolonged intubation, a tracheostomy may provide a number of advantages. This chapter outlines indications, timing, complications and techniques of tracheostomy. Complications of tracheostomy can be classified into perioperative, early and late, with both the type and incidence of specific complications differing between surgical and percutaneous techniques. In some centres routine tracheostomy for ventilator-dependent patients is viewed as an ideal training opportunity, increasing both the duration of the procedure and the risk of surgical misadventure. Ultrasound imaging of the neck prior to tracheostomy allows the anatomy of the anterior neck structures to be identified, particularly the location of blood vessels and the depth and angulation of the trachea. This information may contribute to the risk to benefit analysis between surgical and percutaneous tracheostomy. The chapter also discusses the role of cricothyroidotomy or mini-tracheostomy.