Objective: To explore the clinical application effects of constructing and implementing a microaspiration risk management protocol for neurocritical care patients with artificial airways, providing a reference for reducing microaspiration and aspiration pneumonia incidence. Methods: Patients with artificial airways admitted to neurocritical care-related departments of a hospital from July 2024 to March 2025 were selected as study subjects. A multidisciplinary collaborative team was established to construct a microaspiration risk management system based on evidence-based medicine. Through current situation investigation and analysis of major barrier factors, comprehensive intervention strategies were implemented, including development of a microaspiration risk assessment scale, modified suction depth guidelines, intelligent cuff pressure monitoring, and gastrointestinal management protocols. The volume of subglottic secretion clearance, microaspiration incidence, and aspiration pneumonia incidence were compared before and after the intervention. Results: After implementing the risk management protocol, the volume of subglottic secretion clearance increased from (85.26±13.58) ml to (146.82±21.33) ml; microaspiration incidence decreased from 58.89% to 31.17%; and aspiration pneumonia incidence decreased from 40.77% to 14.72%. All differences were statistically significant (P<0.001). Conclusion: The evidence-based microaspiration risk management protocol for neurocritical care patients with artificial airways can effectively clear airway secretions, reduce microaspiration and aspiration pneumonia incidence, improve patient prognosis, and has high clinical application value.