Tracheostomy is considered as the airway management of choice for patients in the ICU who require prolonged mechanical ventilation or airway protection. Percutaneous dilational tracheostomy (PDT) was first described in 1985 and now is a well-established procedure that can be performed at the bedside by a pulmonologist with less surgical equipment required. A retrospective analysis. Twelve patients underwent PDT because of prolonged endotracheal intubation between March and December 2006. The procedures were done by using bedside percutaneous dilatation tracheostomy with guidewire dilator forceps (GWDF) technique with bronchoscopic guidance under general anesthesia in either the intensive care unit or the intermediate care unit of Department of Medicine, Ramathibodi Hospital. There were seven men and five women with a mean age of 55.0 +/- 11.8 years. Operative mortality was 0%. Procedure related complication was not found Operation time in each case was less than ten minutes. Bronchoscopic examination performed in one of the cases after one month of tracheostomy tube removed showed no scar at the tracheostomy site. PDT with bronchoscopic guidance is a safe and easy procedure that can be done by pulmonologist at the bedside setting.