Antimicrobial Solutions for Endotracheal Tubes in Prevention of Ventilator-Associated Pneumonia

Abstract

Ventilator-associated pneumonia is one of the most frequently encountered hospital infections and is an essential issue in the healthcare field. It is usually linked to a high mortality rate and prolonged hospitalization time. There is a lack of treatment, so alternative solutions must be continuously sought. The endotracheal tube is an indwelling device that is a significant culprit for ventilator-associated pneumonia because its surface can be colonized by different types of pathogens, which generate a multispecies biofilm. In the paper, we discuss the definition of ventilator-associated pneumonia, the economic burdens, and its outcomes. Then, we present the latest technological solutions for endotracheal tube surfaces, such as active antimicrobial coatings, passive coatings, and combinatorial methods, with examples from the literature. We end our analysis by identifying the gaps existing in the present research and investigating future possibilities that can decrease ventilator-associated pneumonia cases and improve patient comfort during treatment.

A new model of endotracheal tube biofilm identifies combinations of matrix-degrading enzymes and antimicrobials able to eradicate biofilms of pathogens that cause ventilator-associated pneumonia

“…Furthermore, ventilator-associated pneumonia recurrence occurs in 26% of patients, with on average 2-5 recurrences per patient; this is often due to failed treatment of the initial pathogen (24). While antimicrobial coated endotracheal tubes can prevent the onset of ventilator-associated pneumonia, few of these have received FDA approval (25). Whilst coated endotracheal tubes reduce ventilator-associated pneumonia incidence, there is little evidence to suggest they reduce crucial patient outcomes including hospital stay, mechanical ventilation duration, or patient mortality.…”

A new model of endotracheal tube biofilm identifies combinations of matrix-degrading enzymes and antimicrobials able to eradicate biofilms of pathogens that cause ventilator-associated pneumonia

“…Furthermore, VAP recurrence occurs in 26% of patients, with an average 2–5 recurrences per patient; this is often due to failed treatment of the initial pathogen [28]. Endotracheal tubes coated with silver or a combination of silver and other metals have been shown to reduce microbial colonization in lab studies and have been approved for clinical use; other innovative antimicrobial tube coatings have not progressed beyond pre-clinical testing [29]. Silver-coated endotracheal tubes have been shown to delay the onset of VAP or reduce its incidence as defined by specific diagnostic criteria; however, there is little evidence to suggest they reduce crucial patient outcomes including ventilator-associated events that fall short of a VAP diagnosis, hospital stay, mechanical ventilation duration or patient mortality.…”