All patients secrete fluids into the upper airway from the base of our tongue and other related structures. These "subglottic" secretions are normally cleared by swallowing, but when a person requires mechanical ventilation that process is blocked by the breathing tube and the subglottic secretions tend to accumulate. The removal of these subglottic secretions is very important because bacteria that normally inhabit the back of our throats can enter and ultimately colonize collected pools of subglottic secretions. This process is called "micro-aspiration" and has been shown to be strong risk factor for the development of Ventilator associated pneumonia (VAP). Previously, doctors and nurses would attempt to limit these secretions by passing small suction tubes through the breathing tube, but this was found to be ineffective and increased the risk for bleeding and lung injury.