Tracheostomycanhelpweaninginlong-termventilatedpatients,reducingtheduration of mechanical ventilation and intensive care unit length of stay, and decreasing complications from prolonged tracheal intubation. Indications and optimal timing for tracheostomy in traumatic brain-injured (TBI) patients are uncertain. This study aims to describe the patients’ characteristics,timing,andfactorsrelatedtothedecisiontoperformatracheostomyandassess the effect of the timing of tracheostomy on patients’ outcomes. We selected TBI patientsfrom Neurosurgerydepartment,PDUmedicalcollegeandcivilhospital,aprospectiveobservational cohort study, with an intensive care unit stay≥72 h. Tracheostomy was defined as early (≤7 days from admission) or late (>7 days). The outcome was assessed at 6 months using the extended Glasgow Outcome Score. Comparative analyses were made among Early Tracheostomy (ET) and late tracheostomy (LT) groups. Our primary outcome was statistical difference of mortality and incidence of VAP between the ET and LT groups in acute brain injury patients. Secondary outcomes included the difference of the duration of mechanical ventilation, ICU length of stay (LOS), and hospital LOS. The total number of participants in the ET group was 149, while in the LT group it was 210. Early tracheostomy reduced risk for incidence of pneumonia, ICU length of stay, overall hospital length of stay and duration of mechanical ventilation, but not mortality. Patients with a late tracheostomy were more likely tohaveaworseneurologicaloutcome,i.e.,mortalityand poorneurologicalsequelsandlonger length of stay (LOS). Tracheostomy after TBI is routinely performed in severe neurological damagedpatients.InTBIpatients,earlytracheostomycomparedwithlatetracheostomymight reduce risk for VAP, ICU and hospital LOS, and duration of mechanical ventilation, but the causality of this relationship remains unproven.