Abstract Background One third of patients with intracerebral hemorrhage (ICH) require mechanical ventilation; in most, tracheostomy may be necessary. Limited data exist about predictors of tracheostomy in ICH. The aim of our study is to identify predictors of tracheostomy in ICH. Methods We reviewed medical records of patients seen in our institution between 2005 and 2009, using ICD-9 codes for ICH, for admission clinical and radiological parameters. A stepwise logistic regression model was used to identify tracheostomy predictors. Results Ninety patients with ICH were included in the analysis, eleven of which required tracheostomy. Patients requiring a tracheostomy were more likely to have a large hematoma volume (≥30mL) (63.4% vs. 29.1%, p=0.037), intraventricular hemorrhage (81.8% vs. 27.8%, p<0.0001), hydrocephalus (81.8% vs. 8.8%, p<0.0001), admission GCS<8 (81.8% vs. 5.1%, p<0.0001), intubation≥14 days (54.5% vs. 1.27%, p<0.0001) and pneumonia (63.6% vs. 17.7%, p=0.003). Stepwise logistic regression yielded admission GCS (OR=80.55, p=0.0003) and intubation days (OR=87.49, p<0.006) as most important predictors. Conclusion We could potentially predict the need for tracheostomy early in the course of ICH based on the admission GCS score; duration of intubation is another predictor for tracheostomy. Early tracheostomy could decrease the time, and therefore risks of prolonged endotracheal intubation and length of hospital stay.