 Insertion of a breathing tube to enable treatment with mechanical ventilation respirator is often associated with complications, such as infection and lung injury. Leakage of secretions around the breathing tube microaspiration is a major factor leading to complications. The investigators propose that a standardized, enhanced oral suction protocol will be effective in reducing microaspiration and harms associated with mechanical ventilation. The investigators hypothesize that those randomized to the enhanced oral suction protocol will have less microaspiration and other ventilator-associated conditions than those in the usual care, standard suction group. 