Objective To compare the clinical performance of percutaneous dilational tracheostomy(PDT) without the assistance of bronchoscopy and surgical tracheostomy(ST). Methods 60 patients were divided into the PDT group and the control group (ST group) and all the operations were performed in the ICU. Differences between the PDT and ST group were investigated, including operation time, size of incision, blood loss, incidence of pneumothorax and subcutaneous emphysema, tracheal esophageal fistula and symtomatic tracheal stenosis , wound infection, healing time, and changes of vital signs in the operation. Results Compared with the control, PDT was more convenient and could significantly reduce the operation time and operative complications. Conclusion Under strict indications, percutaneous dilational tracheostomy can be widely applied in the clinic. Unlike traditional tracheostomy, it is simpler and safer with shorter operative time, less trauma, and fewer complications.