title: Micropatterned Endotracheal Tubes Reduce Secretion-Related Lumen Occlusion.
abstract: Tracheal intubation disrupts physiological homeostasis of secretion production and clearance, resulting in secretion accumulation within endotracheal tubes (ETTs). Novel in vitro and in vivo models were developed to specifically recapitulate the clinical manifestations of ETT occlusion. The novel Sharklet™ micropatterned ETT was evaluated, using these models, for the ability to reduce the accumulation of both bacterial biofilm and airway mucus compared to a standard care ETT. Novel ETTs with micropattern on the inner and outer surfaces were placed adjacent to standard care ETTs in in vitro biofilm and airway patency (AP) models. The primary outcome for the biofilm model was to compare commercially-available ETTs (standard care and silver-coated) to micropatterned for quantity of biofilm accumulation. The AP model's primary outcome was to evaluate accumulation of artificial airway mucus. A 24-h ovine mechanical ventilation model evaluated the primary outcome of relative quantity of airway secretion accumulation in the ETTs tested. The secondary outcome was measuring the effect of secretion accumulation in the ETTs on airway resistance. Micropatterned ETTs significantly reduced biofilm by 71% (p = 0.016) compared to smooth ETTs. Moreover, micropatterned ETTs reduced lumen occlusion, in the AP model, as measured by cross-sectional area, in distal (85%, p = 0.005), middle (84%, p = 0.001) and proximal (81%, p = 0.002) sections compared to standard care ETTs. Micropatterned ETTs reduced the volume of secretion accumulation in a sheep model of occlusion by 61% (p < 0.001) after 24 h of mechanical ventilation. Importantly, micropatterned ETTs reduced the rise in ventilation peak inspiratory pressures over time by as much as 49% (p = 0.005) compared to standard care ETTs. Micropatterned ETTs, demonstrated here to reduce bacterial contamination and mucus occlusion, will have the capacity to limit complications occurring during mechanical ventilation and ultimately improve patient care.
authors.affiliation: Sharklet Technologies, Inc., 12635 E Montview Blvd., Suite 155, Aurora, CO, 80045, USA.
authors.forename: Ethan E
authors.initials: EE
authors.lastname: Mann
authors.affiliation: Sharklet Technologies, Inc., 12635 E Montview Blvd., Suite 155, Aurora, CO, 80045, USA.
authors.forename: Chelsea M
authors.initials: CM
authors.lastname: Magin
authors.affiliation: Sharklet Technologies, Inc., 12635 E Montview Blvd., Suite 155, Aurora, CO, 80045, USA.
authors.forename: M Ryan
authors.initials: MR
authors.lastname: Mettetal
authors.affiliation: Sharklet Technologies, Inc., 12635 E Montview Blvd., Suite 155, Aurora, CO, 80045, USA.
authors.forename: Rhea M
authors.initials: RM
authors.lastname: May
authors.affiliation: Sharklet Technologies, Inc., 12635 E Montview Blvd., Suite 155, Aurora, CO, 80045, USA.
authors.forename: MiKayla M
authors.initials: MM
authors.lastname: Henry
authors.affiliation: Preclinical Translational Services, Wake Forest Baptist Health, Winston-Salem, NC, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: DeLoid
authors.affiliation: Preclinical Translational Services, Wake Forest Baptist Health, Winston-Salem, NC, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Prater
authors.affiliation: Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Sullivan
authors.affiliation: Department of Microbiology and Laboratory Medicine, Allegheny Health Network, Pittsburgh, PA, USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Thomas
authors.affiliation: Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Twite
authors.affiliation: Department of Mathematical Sciences, Center for Biofilm Engineering, Montana State University, Bozeman, MT, USA.
authors.forename: Albert E
authors.initials: AE
authors.lastname: Parker
authors.affiliation: Department of Materials Science & Engineering, University of Florida, Gainesville, FL, USA.|J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.
authors.forename: Anthony B
authors.initials: AB
authors.lastname: Brennan
authors.affiliation: Sharklet Technologies, Inc., 12635 E Montview Blvd., Suite 155, Aurora, CO, 80045, USA. sreddy@sharklet.com.
authors.forename: Shravanthi T
authors.initials: ST
authors.lastname: Reddy
mesh_terms: D018441:Biofilms / Q000254:growth & development*; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000502:physiology*; D008954:Models, Biological; D011550:Pseudomonas aeruginosa / Q000502:physiology*; D012121:Respiration, Artificial / Q000295:instrumentation*; D013499:Surface Properties
keywords: Airway patency model; Biofilm; Endotracheal tube; Mechanical ventilation; Micropattern; Occlusion