Tracheostomy is considered one of the oldest surgical procedures, as archaeological data dates back to ancient Egypt (3600 BC). The indications for tracheostomy are for emergency and elective reasons. The most common indication is airway management in critically ill patients, especially in ICU (70%), while the indication of emergency airway obstruction falls within a small percentage. Deficits in quality of care of a tracheostomy have led to adverse events in 20–30% of all in-patients in UK hospitals. It’s been reported that around 50% of all airway-related deaths and hypoxic brain damage were caused by tracheostomy incidents. The safety of care delivery in tracheostomies depends on education, training, staffing, equipment provision, and infrastructure. Adverse events in adult patients with a new tracheostomy include accidental decannulation, tracheostomy-related haemorrhage, tube obstruction, skin breakdown, failed decannulation, cuff-related airway injury/hypoxaemia, and infection.