Evaluation of Endotracheal Tube Scraping on Airway Resistance

Scott, J Brady; Dubosky, Meagan N; Vines, David; Sulaiman, Adewunmi S; Jendral, Kyle R; Singh, Gagan D.; Patel, Ankeet D; Kaplan, Carl A; Gurka, David P.; Balk, R.A.

doi:10.4187/respcare.05391

Cited by 12 publications

(16 citation statements)

References 8 publications

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“…In the crossover study, despite a single outlier with an isolated large secretion bolus during one SSC suctioning event, the CSC device after a previous SSC suctioning period resulted in a significantly larger increase in secretion volume and secretion weight than with the SSC system. These are similar to results using other mechanical endotracheal tube cleaners [ 15 – 19 ]. Unlike these other systems, however, the CSC system is an integrated closed-suction system that does not require circuit disruption that could result in potential alveolar derecruitment and clinician exposure to pathogens.…”

Section: Discussionsupporting

confidence: 89%

“…Perhaps the most direct approach is to use mechanical devices to physically extract airway secretions out of the tube. First described using standard Fogarty catheters [14], more modern versions use a variety of catheter designs to physically "scrape" the inside of the ETT [15][16][17][18][19]. These devices generally enhance the efficiency of secretion clearance but, unfortunately, they are usually standalone catheters requiring circuit disruption for use and the need for a separate suction system.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a novel endotracheal tube suctioning system incorporating an inflatable sweeper

Davies¹,

Huang²,

MacIntyre³

2021

Can J Respir Ther

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Introduction: Accumulation of secretions in an endotracheal tube can increase the resistance to flow resulting in an increased patient work of breathing when the patient is interacting with the ventilator. Retained secretions can also serve as an infection risk. Standard suction catheters are limited in their ability to keep the lumen of the endotracheal tube clear. A novel closed-suction catheter has been introduced that incorporates a balloon at its distal end that, when inflated, physically scrapes secretions out of the endotracheal tube (CleanSweep catheter (CSC), Teleflex, Morrisville NC). We hypothesized that the CSC would be more efficient at removing secretions from inside the endotracheal tube than a standard suction catheter (SSC). Methods: We performed a bench study examining resistive pressures across different sizes of endotracheal tubes when cleaned by the CSC as compared with an SSC. This study was followed by a prospective crossover study again comparing the CSC with an SSC in intubated intensive care unit patients receiving mechanical ventilation and requiring frequent suctioning. Results: For the bench study the CSC was significantly better in reducing airway resistive pressures (P < 0.001). In the prospective crossover study the CSC over 2 h also removed significantly more secretions than the SSC (P < 0.05). Conclusion: Both our bench and crossover clinical study demonstrated improved clearance of secretions with the CSC vs an SSC. Further research is needed to ascertain the clinical outcome benefits of enhanced secretion removal.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Evaluation of a novel endotracheal tube suctioning system incorporating an inflatable sweeper

Davies¹,

Huang²,

MacIntyre³

2021

Can J Respir Ther

View full text Add to dashboard Cite

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“…Bronchodilator administration may help differentiate reversible airway obstruction due to bronchospasm from fixed obstruction due to endotracheal tube occlusion. Because of the thick, highly viscous nature of secretions, we see a role for endotracheal tube cleaning devices in removing the debris, 30,31 particularly given the risk for respiratory decompensation and disease transmission that could occur during tube exchange or bronchoscopy. 23,25…”

Section: Discussionmentioning

confidence: 99%

Endotracheal Tube Obstruction Among Patients Mechanically Ventilated for ARDS Due to COVID-19: A Case Series

Wiles

Mireles-Cabodevila

Neuhofs

et al. 2020

J Intensive Care Med

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Background: Patients with COVID-19 and ARDS on prolonged mechanical ventilation are at risk for developing endotracheal tube (ETT) obstruction that has not been previously described in patients with ARDS due to other causes. The purpose of this report is to describe a case series of patients with COVID-19 and ARDS in which ETT occlusion resulted in significant clinical consequences and to define the pathology of the obstructing material. Methods: Incidents of ETT occlusion during mechanical ventilation of COVID-19 patients were reported by clinicians and retrospective chart review was conducted. Statistical analysis was performed comparing event rates between COVID-19 and non-COVID 19 patients on mechanical ventilation over the predefined period. Specimens were collected and submitted for pathological examination. Findings: Eleven COVID-19 patients experienced endotracheal tube occlusion over a period of 2 months. Average age was 69 (14.3, range 33-85) years. Mean APACHE III score was 73.6 (17.3). All patients had AKI and cytokine storm. Nine exhibited biomarkers for hypercoagulability. Average days on mechanical ventilation before intervention for ETT occlusion was 14 (5.18) days (range of 9 to 23 days). Five patients were discharged from the ICU, and 4 expired. Average documented airway resistance on admission was 14.2 (3.0) cm H2O/L/sec. Airway resistance before tube exchange was 28.1 (8.0) cm H2O /L/sec. No similar events of endotracheal tube occlusion were identified in non-COVID patients on mechanical ventilation during the same time period. Microscopically, the material consisted of mucin admixed with necrotic cell debris, variable numbers of degenerated inflammatory cells, oral contaminants and red blood cells. Interpretation: Patients with COVID-19 and ARDS on prolonged mechanical ventilation are at risk for developing ETT obstruction due to deposition of a thick, tenacious material within the tube that consists primarily of mucin and cellular debris. Clinicians should be aware of this dangerous but treatable complication.

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“…82 A small randomized clinical trial showed lower ETT colonization and reduced biofilm thickness in the treatment group. 83 The clinical use of similar devices resulted in lower ETT resistance in vivo 84,85 and preserved ETT patency at extubation. 84,86 The use of the mucus shaver might also prevent the loss of antimicrobial activity of tube coatings, as demonstrated by preclinical data; however, a recent small clinical trial conducted with a similar cleaning device failed to show any benefit.…”

Section: Ett Cleaningmentioning

confidence: 98%

Non-Pharmacological Interventions to Prevent Ventilator-Associated Pneumonia: A Literature Review

Coppadoro

Bellani

2019

Respir Care

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Ventilator-associated pneumonia (VAP) is a well-known complication of invasive mechanical ventilation in critically ill patients. The presence of an endotracheal tube (ETT) is one of the major culprits for VAP development: air flow moves pathogens toward the distal airways, while clearance of the trachea is blunted due to reduced tracheal ciliary movement and impaired cough. Several measures are recognized as being useful to prevent VAP, and these are usually grouped in a VAP bundle (ie, avoiding intubation or re-intubation whenever possible; head of bed elevation; hand hygiene; shortening ventilation through sedation interruptions, spontaneous breathing trials, or thromboembolic prophylaxis). However, other interventions have been proposed to reduce VAP rate; some of these interventions have been reported in large clinical trials to be effective, some have been evaluated in small observational studies, and still others at a pre-clinical stage. Some strategies aim to improve the ETT design via a subglottic drainage system, with treatment of the ETT surface to reduce pathogen activity, or by modification of the cuff shape or cuff material to provide a better seal. Another proposed strategy is improving airway care through control of cuff pressure, cleaning the ETT, or use of closed suction systems. Other interventions target a patient's position in the bed to reduce aspiration of digestive content in the airways, or the use of probiotics to modulate gastric flora. Some of these measures are supported by strong evidence, but the impact on relevant outcomes such as duration of ventilation or mortality, as well as cost-benefit ratio, is still unclear, resulting in lack of widespread use.

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Evaluation of Endotracheal Tube Scraping on Airway Resistance

Abstract: This study demonstrated that ETT scraping can reduce R. The decrease in R post-ETT scraping did not affect subsequent SBT success.

Cited by 12 publications

References 8 publications

Evaluation of a novel endotracheal tube suctioning system incorporating an inflatable sweeper

Evaluation of a novel endotracheal tube suctioning system incorporating an inflatable sweeper

Endotracheal Tube Obstruction Among Patients Mechanically Ventilated for ARDS Due to COVID-19: A Case Series

Non-Pharmacological Interventions to Prevent Ventilator-Associated Pneumonia: A Literature Review

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