This chapter provides of indications for intubation in neurologic disease, Knowledge of the control of respiration by higher centers and local reflex mechanism is very essential in understanding the consequences of vital organ damage, airway management, types of intermittent positive pressure ventilation, management of the ventilated patient. Ventilation helps improve gas exchange, decreases the work of breathing, thereby decreasing the oxygen demand and allowing the patient to rest. Neurosurgeons should be aware of the principles of assisted ventilation and related physiology. Neurological patients with less than 10 GCS, ideally require intubation and those with less than 8 GCS, elective ventilation, either as a supportive measure or therapeutic measure. NIV refers to positive pressure ventilation provided without an artificial airway, usually delivered by facemask. However, depressed conscious level and increased secretions are contraindications to its use. Endotracheal intubation should be carried out with adequate sedation and paralyzing agents. Ideally, hyperventilation is employed in conjunction with regular arterial blood pressure, blood gas and ICP monitoring. The goal is an optimum cerebral perfusion pressure. Early tracheostomy has resulted in shorter length of ICU stay. Clinical examination is the best guidance, rather than the recommended criteria, provided there is no pre-existing lung disease or multiorgan failure.