Ventilator-associated pneumonia is a costly complication of hospitalization that lengthens intensive care unit and hospital stay, increasing morbidity and mortality. Among evidence-based measures to prevent ventilator associated pneumonia is the use of a specialized endotracheal tube that aspirates subglottic secretions. Recommendations for subglottic aspiration are found in guidelines by the Centers for Disease Control and Prevention, American Association of Critical-Care Nurses, and the American Thoracic Society. The purpose of this article is to review the available evidence regarding the use of an endotracheal tube with a subglottic secretion aspiration port to prevent ventilator-associated pneumonia. Issues, cost, benefits, and research recommendations will also be discussed.