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Tracheostomy is considered as a strategy that may improve respiratory mechanics and patient comfort and help in the management of secretions and weaning. Tracheostomy has also been suggested as a measure to decrease the risk of development of ventilator-associated pneumonia (VAP), compared with translaryngeal intubation. However, it has not been established whether tracheostomy is an effective strategy for VAP prevention. Data from observational and randomized trials found conflicting results on the relationship between tracheostomy and VAP. A recent large randomized, multicenter, well-designed and conducted study failed to demonstrate a significant reduction in VAP rate in patients who received early compared with late tracheostomy. Physicians' attitudes regarding tracheostomy may be heterogeneous across different intensive care units and the decision to perform tracheostomy is still challenging. In the present article, we therefore aimed to determine the relationship between VAP and tracheostomy, and whether available data suggest that tracheostomy can prevent the occurrence of VAP.