Breathing is vital to life, supplying the body with essential oxygen, removing carbon dioxide, balancing the blood’s acid-base chemistry, and preventing alveolar collapse. If a person cannot maintain ventilation, cardiopulmonary arrest is imminent. A patient on intubated mechanical ventilation depends on the patency of either an endotracheal or tracheostomy tube. The presence of these artificial airways prevents effective mucociliary clearance and cough production, allowing for the accumulation of secretions within the tube. Bacteria rapidly form biofilm colonies throughout the secretions, anchoring to the tube’s surface. Together secretions and biofilm continue to build and will eventually obstruct the airway, if not removed by periodic suctioning. This course reviews open and closed suction techniques and their advantages and disadvantages, identifies associated patient risks, discusses the unique needs of high risk patients, describes the potential for pathogen dispersion, and identifies airway clearance risk-reduction activities.