Tracheotomy is one of the oldest surgical procedures performed, dating back over 3500 years. Knowledge of tracheal anatomy is crucial for performing tracheotomy due to the trachea’s central location and surrounding vital structures. The procedure has evolved significantly, with modern advancements like the percutaneous dilatational tracheotomy (PDT) technique introduced by Pasquale Ciaglia in 1985. These advances have helped make tracheotomy safer and improve access and patient outcomes globally. Despite its benefits, tracheotomy carries inherent risks and requires careful patient selection and preoperative preparation. Credentialing and formal training are essential for performing PDT safely and effectively. Studies suggest that early tracheotomy improves patient comfort, decreases the need for sedatives, and enhances communication, though timing should be individualized. Early tracheotomy is recommended for patients needing prolonged mechanical ventilation to reduce complications such as ventilator-associated pneumonia and mortality. With proper resources and training, the procedure can be safely performed at the bedside in the intensive care unit, with bronchoscopy aiding visualization and reducing complications.