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Routine chest x-ray (CXR) after uncomplicated percutaneous dilatational tracheostomy (PDT) has been shown to be ineffective in diagnosing complications. Based on the available evidence, in 2010 our unit has adopted the approach of omitting the routine CXR after PDT, unless it was clinically indicated. We performed an audit to ascertain that possible life threatening complications are not going unnoticed after PDT without routine CXRs. Retrospective chart review of patients who underwent PDT in our 10-bedded Critical Care unit between 2010-2012. We have reviewed the operation notes to look for immediate complications, the nursing and medical notes for the next 72 hrs to look for early complications and when available, the CXRs taken in the 72 hours postoperative period to look for new and unexpected findings. 136 patients underwent PDT in the 3-year period. All tracheostomies were inserted by ICU or ENT specialist under bronchoscopy guidance. In ten patients the procedure was described as difficult. There were no major complications. In the postoperative period 8 patients had slight oozing from the wound, none of them required intervention. There were 78/136 CXRs taken for other clinical reasons available for review. Meantime difference between the PDT and the CXR was 27 ± 18 hrs. 59/78 of the CXRs were taken to confirm CVP or NG tube placement. None of the CXRs showed any unexpected findings related to PDT. In our experience, omitting the routine postoperative CXR after uncomplicated PDT with bronchoscopy guidance did not increase the rate of unnoticed clinical complications. Our study confirms that adopting these evidence based recommendations does not affect patient safety on the ICU and that routine CXR is not a necessity after PDT.