Purpose Tracheostomies are used in trauma patients in the Intensive Care Unit (ICU) if intubation is likely to be prolonged to facilitate ventilator weaning and neurological or airway assessment. This paper investigates the impact of tracheostomies on ventilation duration and considers factors associated with prolonged ventilation or delayed decannulation. Methodology Patients who had a tracheostomy between July 2020 and July 2025 were identified from the Royal Melbourne Hospital Trauma Registry which captures all injury-related admissions. Data collected included demographics, injury severity, mechanical ventilation hours, length of stay, general and tracheostomy-specific complications. Analysis used χ 2 and Fisher's test for categorical variables and the Mann Whitney U test for continuous ones. Results A total of 102 patients were included. Length of ICU stay was shorter in the early tracheostomy group (defined as tracheostomy 10 days or earlier from intubation) compared with the late group (U = 524, Z = −4.92, p < .001, r = .49). There was no difference when analysing total length of stay or complication rates. Obese patients required longer ventilation post tracheostomy compared with non-obese patients (U=406, Z = -3.02, p = .003, r = .3). Patients who developed pneumonia post tracheostomy took longer to decannulate (U= 697, Z = -2.35, p = .02, r =.24), as did those with major injures (ISS >15) compared with minor injuries (U= 144, Z = -2.68, p =.01, r= .28). Conclusion Earlier tracheostomies were associated with shorter stays in ICU but did not affect complication rates or total hospital stay. Obese patients required longer mechanical ventilation following tracheostomy, suggesting increased difficulty with ventilator weaning and highlighting a potential for early tracheostomy. Patients who developed pneumonia and those with more severe injuries took longer to decannulate and may also benefit from early tracheostomy.