This literature review focuses on the association between the incidence of ventilator-associated pneumonia (VAP) and the time of tracheostomy in different critical settings and analyses literature published during the last five years. VAP is still a major problem in many mechanically ventilated patients, and tracheostomy, bypassing the mouth and allowing better oral hygiene, seems to show a benefit in terms of reduction of incidence of VAP. Recent evidences suggest that tracheostomy, the earlier it is performed, gives a benefit in this sense. Anyway, timing of tracheostomy is strictly depending on the type of critical environment.