I have spent 25 years attempting to take research and theory across the fields of respiratory care, critical care, and anesthesia practice into daily practice. Reading “Ventilator-Associated Pneumonia: Risk Factors and Prevention” by Beth Augustyn in the August issue of Critical Care Nurse (August 2007:32–39) stimulated my critical assessment of how perioperative activities affect patient care.I agree that interventions to prevent VAP should begin at the time of, or if possible, before intubation. For the thousands of surgical patients who will require critical care postoperatively, this can only happen with the cooperation and support of your institution’s anesthesia providers. As Augustyn stated, host risk factors can be identified well in advance, whereas device risk factors in surgical patients are relatively fixed.A successful approach to VAP prevention as described will require a close collaboration among surgeons, anesthetists, and critical care staff with standardization of care that begins well before the patient arrives in the critical care unit. The surgeon could ensure that the patient is scheduled for dental cleansing and plaque removal before major surgery. During the preoperative anesthesia assessment, the anesthesia provider can anticipate the need for postoperative ventilation on the basis of the patient’s physical status, the type and extent of surgery, and the planned surgical time. Anesthesia providers could be responsible for preoperative oral decontamination processes, give initial doses of stress ulcer prophylaxis, and provide for heat and humidification in the anesthesia circuitry. Standard protocols for administering the recommended techniques for the prevention of ventilator-induced lung injury could be initiated during operation instead of many hours later during the postoperative phase. To avoid the need for reintubation with possible aspiration, special endotracheal tubes (silver-nitrated coated or provision for subglottic suction) can be placed by anesthesia during the initial laryngoscopy.Although critical care providers and respiratory therapists are highly experienced in the development and implementation of evidence-based protocol pathways, anesthesia providers generally are not. Standardization of anesthesia care will take the commitment of small groups and gentle prodding from our critical care collaborators over time. Anesthetists need to recognize that they can contribute to the prevention of VAP.