Objective:To explore the application value of the single step dilatational tracheostomy(SSDT) in critically ill patients in the intensive care unit(ICU). Methods:Consecutive sixty-four patients were randomly divided into SSDT group(32 cases) or traditional surgical tracheostomy(ST) group(32 cases). The operation time,incision size,blood loss,changes of vital signs,and postoperative complications such as infection rate,incidence rate of subcutaneous emphysema/pneumothorax,infection rate,and procedure-related mortality were observed. Results:The operation time,amount of blood loss,size of operative incision and changes of vital signs in the SSDT group were superior to those in the ST group (P < 0.05). While the rate of overall complications including wound bleeding,subcutaneous emphysema/pneumothorax,overflow and incision infection was lower in the SSDT group(9.4%) compared with the ST group (53.1%) (P < 0.05). Conclusion:Compared with the ST,the SSDT is more effect,safe,and simple with less perioperative complications for critically ill patients.