While this was a small study of relatively short duration, the results suggest that silver coating endotracheal tubes may offer some help in the battle to prevent VAP. The investigators attempted to recreate “life in the ICU,” where all too frequently patients are managed in a sedated, supine, flat position. The dogs involved in this trial were kept in this same state, which would tend to promote aspiration of the deposited oropharyngeal bacteria and potentiate the subsequent colonization of the lower airway and endotracheal tube. However, at present, there is little to no data to help us understand the significance of decreased numbers of colonizing bacteria on an endotracheal tube. It might be assumed that less is better, but it may be an all-or-none phenomenon. The same issues surround the implications of a decreased aerobic bacterial burden on the eventual development of pneumonia or, more importantly, on ultimate survival. Future trials will need to compare the coated endotracheal tube to our current preventive strategies (ie, elevated head of the bed, rotational/kinetic therapy, continuous subglottic suction, etc.) to see if there is continued or additional benefit. Nonetheless, VAP is an important cause of morbidity, mortality, and increased length and cost of care for the critically ill. If a strategy as simple and likely inexpensive as silver coating the endotracheal tube can prevent VAP, it is indeed the silver lining that we have been searching for. At this time, however, the data are far from complete, and further trials are both needed and warranted.