Abstract Tracheostomy is indicated frequently in the treatment of critically ill patients who require prolonged mechanical ventilation. The purpose of this prospective study was to evaluate our initial experience with 141 cases of percutaneous dilational tracheostomy (PDT) performed over a 2-year period. One hundred twenty pDTs (85%) were placed at the bedside, and 21 (15%) were performed in the operating room in conjunction with other procedures. The procedural complication rate was 11% (16 of 141). Most complications were easily recognized and did not preclude the completion of PDT. One death occurred secondary to severe bronchospasm. The postoperative complication rate was 8% (11 of 141). The most frequent complication was peristomal oozing. The average duration of follow-up after decannulation for patients discharged alive and decannulated was 36 ± 27 weeks. There were 3 recognized cases of clinically symptomatic tracheal stenosis. We conclude that PDT is comparable with the open method and can be performed rapidly and safely at the patient's bedside.