Tracheostomy is one of the most frequently performed surgical procedures in intensive care units (ICUs) for preventing complications caused by prolonged mechanical ventilation. Tracheostomy is advised to remove tracheobronchial secretions, facilitate weaning, and promote early oral feeding. Ventilator-associated pneumonia (VAP) is hospital-acquired pneumonia that develops 48 h after endotracheal intubation in patients without pneumonia at the beginning of intubation. VAP is a significant cause of mortality and morbidity, particularly in critically ill patients. In addition to its already known advantages, it is a debatable issue whether tracheostomy is a risk factor for VAP. The timing of the procedure is a topic that has been discussed in the literature. Previous studies have revealed that tracheostomy can be performed when the predicted intubation duration is 2 weeks or more. In this review, early or late tracheostomy and its effect on VAP development in ICUs will be discussed along with current literature.