Background Major inherent risks associated with percutaneous dilatational tracheostomy include loss of airway during endotracheal tube manipulation, inability to cannulate the trachea below the endotracheal tube, and difficulties related to neck anatomy.

Method Percutaneous dilatational tracheostomy technique was modified to make the incision in the suprasternal area, and the use of air leak technique confirmed tracheal penetration below the endotracheal cuff. Bronchoscopy was not used.

Results One hundred patients underwent percutaneous dilatational tracheostomy using the modification mentioned above. Although three patients had minor bleeding complications, there was no loss of airway; nor were there other complications.

Conclusion This technique provides improved safety from loss of airway and illuminates the need for concomitant bronchoscopy.