Why what we think of the Gold Standard in airway protection is not perfect? Gold standards can improve. The belief that this device works perfectly is trying to explain why we cant prevent Ventilator associated Pneumonia, or why pt still aspirate despite intubation with an endotracheal tube. The intact cuff can only do so much. Atlas is a myth that this Titan can be punished by holding up the world on his shoulders. Really. Not likely. So I dont believe in the myth that the standard ETT is perfect. It can be improved on.