Use of the ultrasound before, during and after percutaneous tracheostomy allows us great advantages; anatomy of the pre and paratracheal region and displaying potential aberrant vessels, and so the needle and dilator to move away from risk areas and ensure the prevention of possible vascular complications. Measuring the distance from the skin into the trachea can be done and this allows us to choose the average size tracheostomy tube.

The aim of this study, In the process of applying percutaneous tracheostomy, to compare the reliability of the traditional landmark method, ultrasound-guided long axis in plane application and ultrasound-guided short axis out of plane application.

Inclusion Criteria:

• hospitalized patients in intensive care
• the decision to open percutaneous tracheostomy
• over 18 years

Exclusion Criteria:

• under 18 years
• Patients with high or unstable intracranial pressure
• Patients with severe coagulation disorders
• Patients attached collar
• hemodynamically unstable patients, despite the use of high doses of vasoactive drugs
• patients with infections in tracheostomy area