Introduction: Ventilator-associated pneumonia (VAP) is a nosocomial infection that occurs in patients with mechanical ventilation (MV). Tracheostomy is a surgical procedure that improves the respiratory mechanics and comfort of the patient which helps with the secretions and weaning. Tracheostomy also reduces the risk for the development of the VAP in comparison to trans laryngeal intubation. Objective: The aim of this study is the assess the role of the tracheostomy in preventing VAP in the intensive care unit (ICU) with mechanical ventilation. Materials and Methods: This is a retrospective study conducted at the neuro-critical ICU of a tertiary care teaching hospital. This study was done in the period from December 2019 to February 2021. The study included 244 ICU patients who underwent tracheostomy and was divided into two groups early and late tracheostomy. All the tracheostomies were performed at the bedside of the patients. The demographic outcomes, ventilator-associated pneumonia, ICU stay, hospital stay and mortality rate of the participating patients were evaluated. Result: The early tracheostomy group (continuous intubation less than 7 days) included 112 patients and 132 patients were included in the late group. A statistically significant difference was found in ventilator-associated pneumonia in the early versus late tracheostomy group. There was no statistically significant difference in the demographics of the two groups. The early tracheostomy has less ICU stay, less hospital stay. But there was no significant difference in mortality rate in comparison to the late tracheostomy group. Conclusion: Early tracheostomy is associated with less ventilator-associated pneumonia, less ICU stay and a higher number of intubation in the early group of tracheostomy