Patients with spontaneous non-traumatic intracerebral bleeding and acute respiratory insufficiency will be considered for a minitracheostomy to help facilitate suctioning and airway clearance. Selected patients will be adults who are intubated for at least 24 hours, who are not candidates for surgical evacuation of the hematoma, and who are considered to be higher risk for extubation failure based on depressed mental status and airway secretions. After obtaining informed consent for the procedure, a spontaneous breathing trial will be performed to make sure that the patient is capable of breathing without the assistance of the mechanical ventilator. A small, 1 cm incision will be made over the cricothyroid membrane using standard aseptic precautions and local anesthesia. The endotracheal tube will be withdrawn, and the minitracheostomy catheter will be passed through the incision into the airway. The minitracheostomy catheter will remain in place until the patient's attending physician feels that it is no longer needed for airway clearance.