Mechanical ventilation in neurologically injured patients presents a number of unique challenges. Patients who are intubated due to a primary neurologic injury often experience respiratory phenomena secondary to that injury, including elevation of intracranial pressure (ICP) in response to mechanical ventilation and variations in respiratory patterns. These problems often require unique ventilator strategies that are designed to minimize the impact of the ventilator on ICP and brain oxygenation. Balancing the need to maintain brain oxygenation and control of ICP can be complicated by the effects of ventilator management on ICP. We will examine the consequences of ventilator management as they relate to parameters that affect ICP and brain oxygenation in patients who have neurologic injury.