A new development in the management of patients requiring mechanical ventilation is the Hi-Lo endotracheal tube. This device has "suction ports" on either side of the tube that allow for the removal of accumulated subglottic secretions.The standard of care is to use this Hi-Lo ET tube and to remove subglottic secretions every 4-6 hours. The Hi-Lo tube is designed to minimize any suction related trauma. Moreover, recent studies of this ET tube have shown that regular suctioning reduces the incidence of VAP. When these "colonized" secretions were treated with antibiotics, it reduced the number of VAP and shortened the time on the breathing machine. The observation that treatment of bacterial colonization of subglottic secretions reduced the time on the breathing machine is potentially very important clinically. In this study, we propose that the development of bacterial colonization directly contributes to respiratory failure and leads to longer times on the ventilator. The primary aim of the study could lead to reduce the time that patients need mechanical ventilation.