To compare the safety and early complications of progressive dilatational tracheostomy (PDT) and forceps dilatational tracheostomy (FDT). Prospective randomized trial. Three-centre university and public teaching hospitals. One hundred and twenty-seven consecutive patients were randomized to undergo PDT or FDT. The duration of the procedure was 7.0 +/- 3.5 min in the PDT group and 6.4 +/- 4.9 min in the FDT group, which was not significantly different. Intraprocedural complications occurred in 14 % with PDT and 31% with FDT (p = 0.03), and were usually minor. Difficult or false insertion of the cannula in eight patients after FDTwas the most common complication. Both percutaneous tracheostomy techniques are safe. The early complication rate of PDT appeared to be lower than FDT, but the early complication rate of FDT may be decreased significantly with small modifications to the set.