Endotracheal Tubes Cleaned With a Novel Mechanism for Secretion Removal: A Randomized Controlled Clinical Study

Abstract

INTRODUCTION: Intubation compromises mucus clearance, allowing secretions to accumulate inside the endotracheal tube (ETT). The purpose of this trial was to evaluate a novel device for ETT cleaning. We hypothesized that its routine use would reduce tube occlusion due to mucus accumulation, while decreasing airway bacterial colonization. METHODS: Subjects were randomized to either the use of the device every 8 h, or the institutional standard of care (blind tracheal suction) only. ETTs were collected at extubation and analyzed with high-resolution computed tomography (HRCT) for quantification of mucus volume. Microbiological testing was performed on biofilm samples. Vital signs and ventilatory settings were collected at the bedside. In-hospital follow-up was conducted, and a final evaluation survey was completed by respiratory therapists. RESULTS: Seventy-four subjects expected to remain intubated for longer than 48 h were enrolled (77 ETTs, 37 treatment vs 40 controls). Treated tubes showed reduced mucus accumulation (0.56 ؎ 0.12 vs 0.71 ؎ 0.28 mL; P ‫؍‬ .004) and reduced occlusion (6.3 ؎ 1.7 vs 8.9 ؎ 7.6%; P ‫؍‬ .039). The HRCT slice showing the narrowest lumen within each ETT exhibited less occlusion in cleaned tubes (10.6 ؎ 8.0 vs 17.7 ؎ 13.4%, 95% CI: 2-12.1; P ‫؍‬ .007). Data on microbial colonization showed a trend in the treatment group toward a reduced ETT-based biomass of bacteria known to cause ventilator-associated pneumonia. No adverse events were reported. The staff was satisfied by the overall safety and feasibility of the device. CONCLUSION: The endOclear is a safe and effective device. It prevents luminal occlusion, thereby better preserving ETT nominal function.

Silver-Coated Endotracheal Tubes Cleaned With a Mechanism for Secretion Removal

“…To optimize the clearance of secretions from the ETT lumen, Kolobow et al 8,9 designed devices to wipe the sur- face of ETTs and devices to intermittently suction secretions to prevent secretion deposition. In a recent clinical trial in 74 critically ill subjects, Pinciroli et al 18 showed that the use of a mechanical wiper to clean the lumen of standard non-coated ETTs reduced ETT-luminal mucus accumulation and decreased ETT-luminal narrowing, thus suggesting a possible decrease in the subject's work of breathing when compared to standard management of ETTs with closed system-suctioning (control group). However, despite the large amount of secretions retrieved from the ETT, bacterial and fungal colonization persisted in the cleaned ETT lumen.…”

“…After informed consent was obtained from the patients or a surrogate, subjects were randomized through sealed envelopes in a 1:1 ratio to receive either standard airway care (blind suctioning) or blind suctioning plus the cleaning maneuver every 8 h. The cleaning maneuver consisted of a single pass of the endOclear device through the ETT, as described in our previous study. 18 Subjects of both groups were cared for according to the VAP-prevention bundle, 19 and ETT cuff pressure was checked every 8 h, with the goal to maintain cuff pressure at 25 cm H 2 O or to match peak pressure if Ͼ 25 cm H 2 O. Immediately before extubation, a sample of tracheal secretions was obtained with a sterile mucus trap.…”

“…In a prior study, we showed that standard noncoated ETTs cleaned with the endOclear were colonized by pathogens expressed as the decimal logarithm of colonyforming units (CFU) per mL (2.85 Ϯ 0.49 logCFU/mL). 14,18,20 Given our hypothesis of a synergistic effect between the 2 devices, we expected ETTs in the treatment group to show an average reduction of 0.5 logCFU/mL compared to silver ETTs without endOclear cleaning. We calculated that 32 subjects (16 for each group) should be enrolled to detect a mean difference for a statistical power of 80% with a 2-sided significance level of 0.05 in a 2-sample t test for mean difference.…”

“…Biofilm mass inside the ETT was obtained as the difference between the weight of the collected tube and the weight of the ETT after biofilm collection, as described previously. 18 Tubes were weighed 3 times with a high-precision scale (PW124, Adam Equipment, Denbigh, United Kingdom), and the 3 results averaged.…”

Evaluation of Endotracheal Tube Scraping on Airway Resistance

“…Endotracheal tube scrapers have been described in the literature as devices that may be able to restore the original internal diameter of the ETT by removing accumulated secretions and biofilm. 3,4 At our institution, we utilize the endOclear (Endoclear LLC, San Ramon, California) to clear secretions when ETT obstructions are suspected. Although we have used it safely, it is unknown what impact its use has had on R aw and overall WOB in spontaneously breathing patients.…”