title: Respiratory therapy device modifications to prevent ventilator-associated pneumonia.
abstract: OBJECTIVE
  Ventilator-associated pneumonia (VAP) is a controversial entity in the field of critical care. After years of research and significant efforts from regulatory agencies and hospitals, this complication is still frequently affecting mechanically ventilated patients, making VAP an active battleground for research. As a result, several preventive measures have recently been tested in experimental and clinical trials. Our interest is focused on those innovations related to the endotracheal tube (ETT).
  
  
  RESULTS
  Four ETT-related VAP causative mechanisms are reviewed, together with different associated potential solutions. Technologies such as the subglottic secretion drainage and the Mucus Slurper have been studied to eliminate subglottic secretion pooling. Novel designs for the cuff and the management of its pressure may avoid leakage. Antimicrobial coatings can prevent endoluminal biofilm formation, whereas using an ETT cleaning device may also be beneficial. Finally, preserving the tracheal ciliary function will keep our best physiologic protection active.
  
  
  CONCLUSIONS
  VAP prevention strategies are a continuously evolving field. Being able to identify the most valuable ideas needs a deep understanding of the disease pathophysiology. The role of the ETT is crucial and there is need for our standards of care to improve. This may soon be possible with newer technologies becoming increasingly available to clinicians.
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pinciroli
authors.forename: Cristina
authors.initials: C
authors.lastname: Mietto
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Berra
mesh_terms: D018441:Biofilms / Q000254:growth & development; D004866:Equipment Contamination / Q000517:prevention & control; D004867:Equipment Design / Q000295:instrumentation; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation*; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*