It is likely that nosocomial pneumonias will continue to be a problem in critical-care areas. If there are to be breakthroughs, they will probably come in the area of prevention, not treatment. Scrupulously sterile techniques when using inhalation therapy equipment, suctioning patients, and changing tracheal tubes remains the mainstay of prevention. Early recognition and aggressive therapy of nosocomial pneumonias have had limited success in decreasing morbidity and mortality rates.