Guide wire cattle horn (GWCH) is a modified approach for percutaneous dilational tracheotomy (PDT). Recent researches showed that this approach was superior to guide wire dilating forceps (GWDF) and guide wire dilating spire (GWDS) in surgery operation skills, dealing with complications and other aspects. In intensive care unit, percutaneous tracheostomy horns expansion technique is a safer minimal invasive technology for critically ill patients who need airway opening, and is worthy of wide application.