There are broadly three groups of patients with tracheotomy in an intensive care unit (ICU) setting: those who required tracheotomy to bypass obstructive disorders; those being ventilated mechanically for a long period of time; and those who have undergone tracheotomy as a preliminary step in certain surgeries of the upper airway, chest, and head. The two accepted methods for performing tracheotomies are open surgical technique and percutaneous dilational technique. This chapter gives an overview of the early complications of tracheotomy, which should be addressed in the ICU. Tracheotomy care can be divided into new versus mature tracheotomy care, but the ICU will most frequently be caring for new tracheotomy sites. A tracheotomy can become dislodged in the ICU during routine care. There are many different strategies for tracheotomy weaning but there is no consensus on the optimal approach. A systematic multidisciplinary approach improves likelihood of success.