Introduction: While multifactorial, VAP etiology remains largely accepted to be secondary to micro-aspiration. Recent developments in endotracheal tube (ETT) cuffs have focused on improved cuff shapes and/or materials. However, to date, the only option for critical care physicians to adopt these improved tubes in previously intubated patients is extubation and re-intubation. In order to provide a tool to reduce micro-aspiration without the risk of extubation and re-intubation, we have developed a novel independent cuff that can be added on to any current standard ETT. One of the first steps in development was to assess in-vitro sealing efficacy of our novel balloon cuff (Bronchoguard, Ciel Medical, CA) in comparison to both standard and improved ETT cuffs. The aim of this study was thus to determine the ex-vivo sealing efficacy of the novel silicone balloon cuff in comparison to current ETT cuffs. We hypothesize that the novel silicone cuff will be more effective at sealing the simulated trachea than existing ETT cuffs given the thin, compliant material and the lack of folds in the cuff upon inflation. Methods: A bench-top model was set up in order to simulate 2 different trachea sizes (18 mm and 20 mm diameter PVC tubes). A minimum of 1-hour leakage of water around cuff was measured for 4 common ETT cuffs and the novel silicone cuff. Tested cuffs were Mallinckrodt Hi-Lo and Taperguard, Teleflex ISIS, Rüsch and Mallinckrodt TaperGuard and compared individually to the novel cuff, using standard T test. Leak rates were measure in cc/min, and experiments repeated 5 to 8 times. Cuff pressure was checked and adjusted every 12 hrs to simulate clinical conditions. Results: Leak rates in 18 mm trachea model (average +/- Standard deviation) Rusch 7.5: 4.37 +/- 2.74 cc/min (p = 0.023) Isis 7.5: 13.93 +/- 6.02 cc/min (p= 0.007) HiLo 7.5: 3.55 +/- 1.65 cc/min (p= 0.009) TaperGuard 7.0: 0.82 +/- 0.52 cc/min (p= 0.025) Novel cuff: 0.01 +/- 0.006 cc/ min Leak rates in 20 mm trachea model (average +/- Standard deviation) Rusch 7.5: 1.99 +/- 1.76 cc/min (p = 0.015) Isis 7.5: 24.94 +/- 8.86 cc/min (p = 0.003) HiLo 7.5: 4.42 +/- 2.23 cc/min (p = 0.011) TaperGuard 7.0: 0.39 +/- 0.72 cc/min (p = 0.30) Novel cuff: 0.006 +/- 0.002 cc/ min Conclusions: The novel endotracheal tube cuff provided statistically significant superior protection against fluid leakage in our bench top model against all standard and improved ETTs in the 18mm tracheal model: 80x to >1000x reduction in leak rate. The results were similar in the 20mm model except for the TaperGuard: while leak rate was on average approximately 65x higher than the novel device, fluid this result failed to reach statistical significance (p=0.3). While clear limitations exist due to the approximative nature of a bench-top setup, the novel device provided significantly better results in reducing leak rate in all but one of 8 comparisons, and non-significantly better results in one. While these results are promising, future studies are required for a more accurate and in-vivo comparison in order to evaluate the real benefit of this novel tool.