Objective To evaluate tracheostoma used in patients with abnormal posture. Methods A total of 96 critical patients admitted to our hospital from January 2005 to December 2010 were retrospectively analyzed. The patients all received normal clinical treatment and were divided into tracheal puncture group(48 cases with abnormal posture) and tracheotomy group(48 cases with normal posture). Patients received percutaneous rotation trachea puncture in tracheal puncture group and traditional surgical tracheostomy in tracheotomy group. Vital signs and medical indices of patients in the two groups were assessed. Results Compared with tracheostomy, percutaneous rotation trachea puncture had no requirement for posture, which was safe and rapid with small damage and simple operation. Vital signs in tracheal puncture group, such as mean artery pressure(MAP), heart rate(HR) and central venous pressure(CVP) were significantly lower than those in tracheotomy group[MAP: (90±12) vs (118±10)mmHg; HR: (85±9) vs (106±12)/min; CVP: (7±4) vs (9±3)cmH2O; P＜0.01]. Conclusion In critical patients with abnormal posture, percutaneous rotation trachea puncture is obviously superior to traditional surgical tracheostomy and is well worth recommded clinically.