Introduction Identification of newer trends in indications and timing of tracheostomy and their implication on the outcome of the patients in a critical care unit, based on observations recorded in patients from a tertiary care centre in Western India.   Materials and Methods 100 patients admitted in the critical care unit, who underwent tracheostomy, were studied retrospectively. The patients were analyzed for the epidemiological data, indications, timing, and outcome of the tracheostomy. The outcomes were assessed based on mortality, discharge, decannulation, complications and VAP as parameters. A comparative analysis of the outcome of the tracheostomy depending on the timing of tracheostomy was conducted.   Results Male: Female ratio was 1.77:1. Majority of the patients belonged to the age group of 21 to 40 years. Anticipation of prolonged airway was commonest indication for tracheostomy (49%). Early tracheostomy was preferred (68%). The mortality rate was 38%. 48% of patients were discharged with a successful decannulation in 72.9% of them. Complications and VAP were observed in 16% and 23% of patients, respectively. The timing of tracheostomy had a significant impact on the outcome.   Conclusion Anticipating prolonged intubation is the most important indication for tracheostomy in the critical care unit. Early tracheostomy is associated with favourable outcomes in terms of decreased mortality, improved survival rate, lesser complication, low incidence of VAP, and thus, better weaning. As soon as the need for prolonged management of the airway is identified, tracheostomy should be considered.