Tracheostomy, a surgical procedure that creates a stoma in the trachea, has its origins in ancient Egypt and Greece, but gained prominence during the polio epidemics of the 1950s and 1960s. The practice has evolved significantly with the development of intensive care units in the 1970s and 1980s, participating in the therapeutic arsenal used for weaning. The main indications for tracheostomy include prolonged intubation, airway obstruction due to tumors, bilateral vocal cord paralysis, and airway protection in neurological disorders. The procedure offers several advantages over orotracheal tubes, including less airway resistance, better oral hygiene, less need for sedation, and shorter ICU stay. Despite these benefits, tracheostomy carries risks of immediate, early, and late complications, including bleeding, infection, and tracheal stenosis. Recent studies suggest that early tracheostomy may reduce the incidence of nosocomial pneumonia and mortality in adults, but does not significantly improve survival without severe disability in patients with severe neurological disease. Tracheostomy plays a critical role in modern intensive care, and the appropriate timing for its performance is still open for future discussion.