This study is to assess the role of subglottic suctioning in patients requiring mechanical ventilation in the Medical ICU.  As a part of standard care in intubated patients, the secretions from the respiratory tract are periodically suctioned through the endotracheal tube using sterile suction catheters. However it was shown in multiple observational studies that the subglottic space between the vocal cords and the bulb of the ET tube harbors a pool of secretions that are not accessible for routine suctioning. This pool of secretions forms a focus for colonization of various bacteria which are shown to be responsible for Ventilator Associated Pneumonia (VAP). VAP prolongs the duration of ICU stay as well the mortality of the patient.  Also the financial burden due to a VAP is not only the cost of additional ICU stay but also the second line antibiotics which are often used in its treatment.

The central idea of this study is an intervention enabling the clearance of the subglottic pool of secretions and its ability in prevention of VAP. Patients will be randomized to get either routine endotracheal suctioning alone or subglottic suctioning in addition to the routine endotracheal suctioning. Subglottic suctioning is done through a port which opens into the subglottic region in specially designed ET tubes. Multiple randomized control trials world over have shown benefit with subglottic suctioning in the prevention of VAP, however data from a developing countries is lacking. We aim to show improved rates of VAP per ventilator days.