Background: Tracheostomy is one of the most frequently performed procedures in intensive careunits. The widespread attraction of percutaneous dilatational tracheostomy (PDT) is increasing inmodern intensive care units (ICU). Bronchoscopic guidance seems to secure the safety of thetechnique. Multiple studies done to explain characterize differences in complications and costeffectivenessof open and percutaneous tracheotomy. The objective of this study was to evaluate thebenefits of percutaneous dilatational tracheostomy (PDT) using the Ciaglia technique withbronchoscopic guidance.Methods: A total of ۱۰۰ elective percutaneous dilatational tracheostomies using the Ciagliatechnique with a little modification were performed under flexible fiber optic bronchoscopic guide.The demographic variables were recorded; the underlying cause for patient’s referred to the centerfor PDT, and intraoperative as well as early postoperative complications. Patients followed forseveral days after tracheostomy for early complications.Results: No severe complications related to percutaneous dilatational tracheostomy were noticedduring and after the procedure. Three patients had bleeding during incision and two led tosubcutaneous hematoma. There were no other complications such as infection, emphysema andpuncture of posterior wall.Conclusions: We recommended the use of endoscopic guidance bedside percutaneoustracheostomy using the Ciaglia technique with a little modification because it is safe and simple todo without significant complications. PDT with bronchoscopic guidance is a safe and easyprocedure that can be done at the bedside setting.