Objectives: Evaluate the epidemiological, clinical features and the care of of tracheostomy of severe trauma brain injury patients. Methods: Prospective study of 38 tracheostomy of severe trauma brain injury patients between 10/2011-4/2012. Results: Patients age ranged from 10 - 65 years old. Male/female 6,6/1.The main cause is motor vehicle accident, working age 19-59 were 84,2 percent . Tracheostomy timing after 72h were 55,3 percent. The CT Scan showed the most common image were local or diffuse brain contusion with subarachnoid hemorrhage 52,6 percent. Conclusions: The mortality rate still high 23,7 percent. The patient of the discharged less than 7 days group had low risk of pulmonary infection than the rest group. Early tracheostomy reduce the risk of pneumonia and the days of mechanical ventilation.