ETTs coated with antimicrobial substances have been studied as a means to decrease bacterial colonization and prevent biofilm production with the ultimate hope of reducing VAP rates. It is hypothesized that microorganisms reach the ETT either as a consequence of a contaminated oropharynx or reflux of gastric secretions29. Once they reach the ETT surface, microorganisms produce biofilms, which provide an ideal environment for growth and proliferation protected from the host’s natural defenses. When biofilms subsequently become dislodged, either spontaneously or iatrogenically due to suctioning or bronchoscopy, there is significant risk for development of late-onset VAP.