There is no accepted standard for the frequency of monitoring endotracheal tube cuff pressures (ETCP). We plan on comparing two strategies for monitoring ETCP in mechanically ventilated patients. The two strategies will be the currently employed practice protocol as outlined in the Respiratory Therapy Protocol at Barnes-Jewish Hospital (BJH) which requires ETCP to be assessed immediately after the endotracheal tube is placed and after any manipulation of the endotracheal tube to include repositioning, manipulation of the cuff volume, or presence of an audible leak. We will compare this current practice to a more intensive monitoring of ETCP which is employed at some hospitals and includes the same elements as noted in the current practice plus monitoring ETCP every work shift (every 8 hours or three times per day). The ETCP will be assessed using a standard manometer. The two practices will be compared between patients assigned to odd and even beds in the medical ICU (8400 ICU) with odd numbered patients having the current ETCP practice and those in even rooms having the addition of ETCP assessments every shift. It is important to note that the respiratory therapists carrying out the ETCP assessments are simply performing their jobs as therapists in a normal manner to include the assessment of ETCPs. The respiratory therapists come in to work in the ICU and carry out their jobs according to the current protocol in that unit. ETCP assessments are a routine part of their job. They will be simply carrying out their job according to protocol based on the room number the patient is in. Assessing ETCPs takes less than 1-2 minutes to carry out. The respiratory therapists working in the medical ICU will be carrying out their jobs in a normal way. Respiratory therapy practices and protocols are frequently changed over the course of time. The therapists will continue to carry out their jobs in a routine manner in the medical ICU.