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Tracheostomy is a very common procedure in neurosurgical ICU patients. In order to improve the respiratory dynamics and for the ease and effi ciency of chest physiotherapy, patients with depressed level of consciousness who cannot be extubated early are considered for tracheostomy. In addition to that, complications of prolonged orotracheal intubation also Outcome Difference in Neurosurgical Patients Based on Timing of Tracheostomy and Ventilator Associated Pneumonia Pratyush Shrestha MS, MCh Neurosurgeon