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INTRODUCTION: Percutaneous tracheostomy should be considered for patients requiring mechanical ventilation for more than two weeks It helps in respiratory weaning and it reduces the length of stay in intensive care unit The use of fibre-optic bronchoscopy became a standard during percutaneous tracheostomy procedure It reduces the risk of complications Using fibre-optic bronchoscopy in COVID-19 patients carries the risk of spread of infection via aerosolized air One of the biggest concerns performing a tracheostomy in COVID-19 positive patients is the risk of transmission of infection to the ICU staff METHODS: The study involved 59 intubated patients who were COVID-19 positive and ventilated for more than 2 weeks All patients were pre-oxygenated with 100% FiO2, moderately sedated with propofol and fentanyl and paralyzed with rocuronium Intubation box was used to cover the patient head and neck The ventilator was on standby while the ETT was exchanged with an I-gel size 5 for men and 4 for women The second tracheal ring was selected in most patients and the percutaneous tracheostomy was performed while the operator's hands were inside the intubation box Once the tracheostomy tube was inserted the position was checked by CO2 absorber, tidal volume and chest movement Chest X-ray was ordered to confirm position of the tracheostomy tube RESULTS: We performed 59 tracheostomies in our institute The average BMI was 29 kg/m2 The largest BMI was 72 kg/m2 The mean length of length of stay post tracheostomy in ICU was 10 7 day There is no significant correlation between early and late tracheostomy with the total ventilation days nor the immediate and delayed complications Early tracheostomy was correlated with higher mortality in this cohort of patient P0 01 while late tracheostomy was significantly correlated with more discharge from ICU We encountered one delayed onset pneumothorax in one patient and no other complications were reported Non of the ICU staff involved got infected CONCLUSIONS: The use of I-gel and intubation box to insert percutaneous tracheostomies for Covid -19 patients is a safe technique both for patients and the ICU staff There was no correlation between early tracheostomy and reduction of ICU mortality