Respiratory complications in patients with traumatic cervical spinal cord injury (TSCI), particularly those with high cervical lesions, present a complex challenge requiring individualized ventilatory strategies. This chapter examines the critical role of tailoring respiratory management to the level and severity of the injury, emphasizing the importance of understanding the diverse physiological trajectories associated with different lesion types. Key topics include the process of weaning from mechanical ventilation, incorporating clinical stability assessment, optimization of invasive mechanical ventilation, and the use of non-invasive ventilation (NIV) and mechanical/manual cough assistance post-extubation. Decision-making surrounding tracheostomy timing is explored, comparing early and late interventions. The chapter also delves into tracheostomy decannulation strategies, addressing airway patency, speech options, and patient education. The role of diaphragmatic pacing stimulation (DPS) as an innovative intervention to enhance respiratory function and reduce dependence on mechanical ventilation is discussed in detail, covering patient selection, surgical considerations, and post-operative rehabilitation. The challenges and benefits of integrating DPS into home-based care are also highlighted, alongside the critical role of family support. By emphasizing the need for individualized ventilatory strategies based on lesion-specific considerations, this chapter provides a comprehensive framework for optimizing respiratory care and improving outcomes for cervical TSCI patients.