title: Endotracheal tubes: old and new.
abstract: The development and evolution of the endotracheal tube (ETT) have been closely related to advances in surgery and anesthesia. Modifications were made to accomplish many tasks, including minimizing gross aspiration, isolating a lung, providing a clear facial surgical field during general anesthesia, monitoring laryngeal nerve damage during surgery, preventing airway fires during laser surgery, and administering medications. In critical care management, ventilator-associated pneumonia (VAP) is a major concern, as it is associated with increased morbidity, mortality, and cost. It is increasingly appreciated that the ETT itself is a primary causative risk for developing VAP. Unfortunately, contaminated oral and gastric secretions leak down past the inflated ETT cuff into the lung. Bacteria can also grow within the ETT in biofilm and re-enter the lung. Modifications to the ETT that attempt to prevent bacteria from entering around the ETT include maintaining an adequate cuff pressure against the tracheal wall, changing the material and shape of the cuff, and aspirating the secretions that sit above the cuff. Attempts to reduce bacterial entry through the tube include antimicrobial coating of the ETT and mechanically scraping the biofilm from within the ETT. Studies evaluating the effectiveness of these modifications and techniques demonstrate mixed results, and clear recommendations for which modification should be implemented are weak.
authors.affiliation: Adult Respiratory Care chaas@umich.edu.
authors.forename: Carl F
authors.initials: CF
authors.lastname: Haas
authors.affiliation: Adult Respiratory Care.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Eakin
authors.affiliation: Adult Respiratory Care.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Konkle
authors.affiliation: Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Ross
authors.initials: R
authors.lastname: Blank
mesh_terms: D018441:Biofilms; D004867:Equipment Design; D004869:Equipment Safety; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D007823:Laryngeal Nerves / Q000502:physiology; D053685:Laser Therapy; D016343:Monitoring, Intraoperative; D009873:Operating Rooms; D012307:Risk Factors
keywords: Hunsaker Mon-Jet tube; Parker Flex-Tip; RAE tube; biofilm; bronchial blocker; cuff pressure; double-lumen tube; endotracheal tube; laser-resistant tube; microaspiration; polyurethane; silver-coated endotracheal tube; subglottic secretion drainage; tapered cuff; ventilator-associated pneumonia