Concerns have been raised about the use of subglottic suctioning devices experiencing mechanical failure due to blockage of the subglottic suction port by tracheal mucosa or causing injury to the tracheal mucosa23. However, changes in design of the tubes have reduced these complications at the expense of higher cost of the tubes24. Additionally, as there is no difference in VAP reduction rates between continuous and intermittent subglottic suctioning techniques21, intermittent suctioning should be considered, as there may be less risk of associated tracheal injury. Further studies are needed to confirm this recommendation.