Background: Supportive respiratory care and airway management are very important in treating COVID-19 patients with respiratory failure. There are two techniques for supporting patients with respiratory failure. Objectives: The current study aims to evaluate the efficacy and quality of patient care with early tracheostomy in intensive care unit (ICU) and compare mortality, hospital stay, and outcome between intubation and early tracheostomy. Methods: This study is conducted on total patients with confirmed COVID-19 in the ICU centers of a tertiary hospital. At the beginning of the study, all patients were intubated and connected to a mechanical ventilator. Within three days, the intensivists randomly performed bedside percutaneous dilational tracheostomy (PDT) for half of the patients. Early tracheostomy was defined as conducting tracheostomy within three days from intubation. Results: The total number of 36 patients was included in the study and categorized into two groups, including 18 patients in the early tracheostomy and 18 in orotracheal intubation. Half of the patients (50%) in the tracheostomy group were recovered from COVID-19 respiratory failure and discharged from ICU and hospital. All patients in the intubation group were expired. The length of staying alive in ICU in patients with an early tracheostomy was 26.47±3.79 compared with 7.58±2.36 days in intubated patients. Conclusion: The early tracheostomy compared with orotracheal intubation in respiratory failure patients with COVID-19 can significantly decrease mortality. However, airway management with an early tracheostomy increases the hospitalization stay and can increase recovery. So, conducting the early tracheostomy is recommended in this study.