RESPIRATORY INFECTIONS: Edited by Michael S. NiedermanRespiratory therapy device modifications to prevent ventilator-associated pneumoniaPinciroli, Riccardo; Mietto, Cristina; Berra, LorenzoAuthor Information Department of Anesthesia, Critical Care and Pain Medicine, Boston, Massachusetts, USA Correspondence to Lorenzo Berra, MD, Department of Anesthesia, Critical Care and Pain Medicine, 55 Fruit Street, Boston, MA 02114, USA. Tel: +1 617 643 7733; e-mail: [email protected] Current Opinion in Infectious Diseases: April 2013 - Volume 26 - Issue 2 - p 175-183 doi: 10.1097/QCO.0b013e32835d3349 Buy Metrics Abstract Purpose of review Ventilator-associated pneumonia (VAP) is a controversial entity in the field of critical care. After years of research and significant efforts from regulatory agencies and hospitals, this complication is still frequently affecting mechanically ventilated patients, making VAP an active battleground for research. As a result, several preventive measures have recently been tested in experimental and clinical trials. Our interest is focused on those innovations related to the endotracheal tube (ETT). Recent findings Four ETT-related VAP causative mechanisms are reviewed, together with different associated potential solutions. Technologies such as the subglottic secretion drainage and the Mucus Slurper have been studied to eliminate subglottic secretion pooling. Novel designs for the cuff and the management of its pressure may avoid leakage. Antimicrobial coatings can prevent endoluminal biofilm formation, whereas using an ETT cleaning device may also be beneficial. Finally, preserving the tracheal ciliary function will keep our best physiologic protection active. Summary VAP prevention strategies are a continuously evolving field. Being able to identify the most valuable ideas needs a deep understanding of the disease pathophysiology. The role of the ETT is crucial and there is need for our standards of care to improve. This may soon be possible with newer technologies becoming increasingly available to clinicians. Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.