Endotracheal suctioning of secretions through a ventilatory prosthesis (orotracheal or tracheostomy tube) is not a riskless procedure. Despite international literature is lacking both on the ways and on the times of suction, since long ago the main recommendations are that the procedure should be carried out with the minimum frequency or when clinically indicated by the presence of secretions in the ventilatory prosthesis. The early indicators for the diagnosis of bronchial secretions retention are: change in the volume flow loop (presence of a “saw tooth” track); presence of coarse crackles (detectable by dedicated tools); increase in peak pressure in volumetric ventilation or decreased current volume in pressometric ventilation, arterial desaturation. In the absence of these indicators do not perform “routine aspirations.”