Early tracheostomy in critically ill patients suffering from non-neurological illness requiring prolonged mechanical ventilation (PMV) has variable results benefits in terms of reducing ventilator-associated pneumonia (VAP), weaning time from mechanical ventilation (MV), intensive care unit (ICU) stay, and short-term mortality. Earlier studies done in neurological patients suffering from traumatic brain injury, stroke, subarachnoid hemorrhage and postoperative patients of infratentorial tumors has shown some benefits in terms of VAP, ICU stay but no benefit in terms of functional recovery and mortality at subsequent follow up. Scarce literature is available on timing of tracheostomy in patients undergoing surgery for brain tumor (including both supratentorial and infratentorial) and risk factors responsible for PMV postoperatively. Majority of these cases are capable of spontaneous breathing preoperatively and not critically ill. In such patients, preexisting risk factors, including altered consciousness; features of increased intracranial pressure; abnormalities in routine blood investigation, such as hyponatremia and leukocytosis;deranged arterial blood gas (ABG) parameters, such as PaO2 and PaCO2 ; intraoperative events, such as massive blood transfusion; venous embolism; fluid overload; and postoperative complications, such as meningitis, operative site edema with midline shift, and lower cranial nerve palsies, are more predictive of PMV requirement than illness severity scores, including Acute Physiology And Chronic Health Evaluation (APACHE) II, APACHEIII, and Infection Probability Score, as reported in the literature for critically ill patients suffering from nonneurological illness.