Incidence of ventilator associated pneumonia (VAP) in brain injury patient ranges from 28 to 40 %. Brain injury may induce immunosuppression explaining why neurotraumapatients are at higher risk of developing early onset pneumonia. However, occurrence of pneumonia in brain injury patient has not been associated to higher mortality. Many methods such as selective digestive decontamination, early administration of antibiotics, continuous subglottic aspiration, improved initial choice and dosage of antibiotic, may be useful to prevent and treat VAP in brain injury.