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. We will examine the consequences of ventilator management as they relate to parameters that affect extubation, ICP, and brain oxygenation in patients who have neurologic injury. These problems often require unique ventilator strategies that are designed to minimize the impact of the ventilator on ICP and brain oxygenation, and allow for appropriate liberation from the ventilator.