Benefits of tracheotomy include improved patientcomfort, better oral hygiene, and easier nursing care. However, the timing (early vs. late) of the tracheotomy in critically ill patients requiring prolonged mechanical ventilation (PMV) remains unclear. The objective of this article was to systematically explore the evidence on timing of tracheostomy in critically ill patients predicted to beon PMY. A systematic literature search of PubMed, Trip database, the Cochrane Library, and the Chinese Electronic Periodical Service was conducted using specific search terms. Electronic searches were performed using Boolean logic, Medical Subject Headings, and the appropriate corresponding keywords. We did not impose any language restriction in database searches. We selected one relevant literaturewhich met our PICO. It included four studieswith a high risk of bias, in which a total of 673 patients were randomized to either early or late tracheostomy. There was no significant difference between early and late tracheostomies for patient mortality. In one study a statistically significant result favouring early tracheostomy was observed in the outcome measuring time spent on ventilator support. The evidence in this Cochrane reviewis insufficient to recommendeither early or late tracheostomy for critically ill patients. Additional high quality randomized controlled trials are necessary to evaluate possible differences between early and late tracheostomyfor critically ill patients.