Ventilator-associated pneumonia (VAP) is a serious and costly clinical problem affecting pediatrics today. This device-related infection is thought to be directly linked to the colonization of the endotracheal tube (ETT) during long-term mechanical ventilation. Because of unspecific radiographic and clinical signs, VAP is especially difficult to diagnose in the pediatric population. Treatment with antibiotics is often ineffective, and VAP is associated with high morbidity, mortality, and medical costs. The use of nanomodified coatings on ETT may provide an effective strategy to prevent biofilm formation and ETT colonization. Nanoparticles such as selenium and iron oxide have been shown to penetrate into the biofilm reaching the protected cells antibiotics often miss. Moreover, nanoetching techniques can modify the topography of the ETT surface interfering with bacterial adhesion. This review seeks to examine the antimicrobial properties of both nanoparticles and nanomodified surfaces and to characterize their effectiveness at reducing bacterial colonization on ETT.