Background: Some patients who are predicted to need extended endotracheal intubation have conflicting recommendations on when to perform a tracheostomy. ObjectiveTo assess the effects of early tracheotomy versus late tracheotomy in stroke patients on the occurrence of ventilator-associated pneumonia (VAP), the time required to wean off MV, the length of ICU stay, and the ultimate result. Concerning the Materials and Techniques: Eighty adult male and female patients with a diagnosis of acute ischemic or hemorrhagic stroke were split into two groups: those who had tracheotomy early and those who underwent it later. Until 40 patients were enrolled in each group, the trial continued. Results indicated that there was no statistically significant difference in age or gender between the two groups. Most people in both groups reported a family history of hypertension or diabetes (70% in group (1) and 55% in group (2)). Furthermore, APACHE II (p=0.11), SETscore (p=0.09), and intubation cause (p=0.58) showed no statistically significant group differences. Before and after tracheostomy, there were statistically significant variations in VAP (P 0.001), MV duration (P 0.001), MV weaning (P 0.001), and ICU stay (P =.045). The current study concluded that in stroke patients who are expected to need prn ventilation, early tracheotomy (within 7 days from intubation) should be considered. This was because early tracheotomy was associated with decreased incidence of VAP, faster weaning from MV, reduced length of ICU stay, decreased mortality rate, and increased probability of discharge from ICU (more than 7 days).