Modifying endotracheal tubes to prevent ventilator-associated pneumonia.
OBJECTIVE
The endotracheal tube (ETT) is the main avenue leading to airway contamination and subsequent ventilator-associated pneumonia (VAP) during mechanical ventilation. A number of modifications to the ETT are available, aimed at reducing the incidence of VAP. We review here available systems and devices, and clinical data regarding their efficacy.


RESULTS
Three main modifications of ETTs have been developed: coating with antimicrobials, adding a suction channel for the removal of oro-pharyngeal secretions, and modifying the design of the cuff. Each of these interventions has been shown to limit bacterial colonization of the distal airways and to decrease the incidence of VAP. Data on their ultimate effect on related clinical outcomes are still lacking.


CONCLUSIONS
Modifications of ETTs aimed at decreasing the onset of VAP show promising results. However, the lack of a significant effect on outcomes prompts us to use caution before recommending their widespread use.
Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Andrea
A
Coppadoro
Lorenzo
L
Berra
Luca M
LM
Bigatello
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D004322:Drainage; D004867:Equipment Design; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods*; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*
D000900:Anti-Bacterial Agents