Nosocomial pneumonia (NK) is one of the most frequent complications of polytrauma leading to death. Meanwhile, the recommendations on prevention of NK in case of polytrauma have not been specified so far. This is due in large part to the lack of study of the pathophysiology of severe combined trauma. The review presents the results of modern experimental and clinical studies of the effect of shock, immune distress syndrome, posttraumatic immunosuppression, the phenomenon of mutual aggravation of lesions, age, sex, concomitant pathology on the risk of NK in polytrauma. The role of iatrogenic risk factors for NK in polytrauma – intubation of trachea and artificial lung ventilation (AVL), massive hemotransfusions, immobilization, the phenomenon of “second strike” after multiple surgeries has been determined. The most effective measures of NK prevention are reduction of the duration of AVL, prevention of oropharyngeal colonization and aspiration in case of AVL, use of inhalation antibacterial drugs, anti-shock measures, early mobilization of the patient, the earliest possible stable functional osteosynthesis by minimally traumatic methods. The data on the effectiveness of selective decontamination of intestines, probiotics and glucocorticosteroids for the prevention of NK in polytrauma are inconsistent. A promising area of NK prophylaxis may be the development of agents that regulate the complex mechanisms of immune response to polytrauma and prevent secondary acute lung injury and post-traumatic immunosuppression.