title: Endotracheal Tubes Cleaned With a Novel Mechanism for Secretion Removal: A Randomized Controlled Clinical Study.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  The endOclear is a safe and effective device. It prevents luminal occlusion, thereby better preserving ETT nominal function.
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pinciroli
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Cristina
authors.initials: C
authors.lastname: Mietto
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Annop
authors.initials: A
authors.lastname: Piriyapatsom
authors.affiliation: Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Chenelle
authors.affiliation: School of Dentistry, West Virginia University, Morgantown, West Virginia.
authors.forename: John G
authors.initials: JG
authors.lastname: Thomas
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Pirrone
authors.affiliation: Center for Clinical and Translational Metagenomics, Department of Pathology, Brigham & Women's Hospital, Boston, Massachusetts.
authors.forename: Lynn
authors.initials: L
authors.lastname: Bry
authors.affiliation: Center for System Biology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Wojtkiewicz
authors.affiliation: Center for System Biology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Matthias P
authors.initials: MP
authors.lastname: Nahrendorf
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.|Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kacmarek
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts lberra@mgh.harvard.edu.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Berra
mesh_terms: D000368:Aged; D018441:Biofilms; D004866:Equipment Contamination / Q000517:prevention & control*; D004869:Equipment Safety / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D009093:Mucus / Q000382:microbiology; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology / Q000517:prevention & control; D013396:Suction / Q000379:methods
keywords: VAP (ventilator-associated pneumonia); airway obstruction; biofilms; intubation; ventilation