Ventilator Associated Pneumonia Secretions Saline should never be instilled into ETTs in order to break up secretions because as little as 5 cc can dislodge up to 300,000 bacterial colonies [Am J Crit Care 3: 444, 1994]. NAC can be instilled (direct instillation preferred over aerosol, which is irritative) to break up mucus plugs. Because […]