This chapter aims to explore the multifaceted of mechanical ventilation (MV) in neurocritical care, identifying the controversies that arise when managing patients with neurological injuries. Key topics that are discussed include the following: Through a comprehensive review of these topics, this chapter will provide clinicians with critical insights into the effective management of mechanical ventilation in neurocritical care settings. The aim is to enhance patient outcomes, facilitate neurological recovery, and address the complex interplay between neurological injury and respiratory failure.