Evaluation of a Closed Suction System With Integrated Tube-Scraping Technology

• Published in: Respiratory care Vol. 68; no. 8; pp. 1023 - 1030
• Main Authors: Kaur, Ramandeep, Scott, J Brady, Weiss, Tyler T, Klein, Andrew, Charlton, Megan E, Villanueva, Kimberly A, Balk, Robert A, Vines, David L
• Format: Journal Article
• Language: English
• Published: United States Daedalus Enterprises, Inc 01.08.2023; Daedalus Enterprises Inc
• Subjects: Adult; Artificial respiration; Editor'S Choice; Female; Humans; Intubation; Intubation, Intratracheal - adverse effects; Lung; Maintenance and repair; Male; Methods; Middle Aged; Respiration, Artificial - adverse effects; Respiratory intensive care; Suction (Medical care); Suction - adverse effects; Trachea; Ventilator Weaning; Ventilators; Ventilators, Mechanical; United States; VAP (ventilator-pneumonia); airway obstruction; mechanical ventilation; secretion clearance; biofilm; endotracheal tube
• ISSN: 0020-1324; 1943-3654; 1943-3654
• DOI: 10.4187/respcare.10830

Endotracheal tube (ETT) scraping or sweeping refers to mucus removal from an ETT that can increase airway resistance. The study objective was to evaluate the effect of ETT scraping on the duration of mechanical ventilation, time to first successful spontaneous breathing trial (SBT), duration of hospital stay, and occurrence of ventilator-associated events (VAEs). This was a single-center, randomized clinical trial of adult subjects intubated between October 2019-October 2021. Subjects were randomly assigned to either ETT suctioning via a standard in-line suction catheter (control group) or ETT suctioning and scraping via a suction catheter with balloon-sweeping technology (experimental group). Airway suctioning was performed as clinically indicated, and the ETT was scraped every time a respiratory therapist suctioned the subject. The study outcome was duration of mechanical ventilation, time to first successful SBT, hospital length of stay, and VAE rate. Intent-to-treat statistical analysis was performed. Of 272 randomized subjects, the median age was 63 (interquartile range [IQR] 52-73) y; 143 (53%) were males, and 154 (57%) had a primary diagnosis of acute respiratory failure. There were no significant differences between the groups in median duration (h) of mechanical ventilation (72 [37-187] vs 70.6 [37-148], = .58). There was no significant difference between the study groups in median time (h) to the first successful SBT (46.7 [IQR 30-87] vs 45.7 [IQR 27-95], = .81), length of hospital stay ( = .76), the incidences of ventilator-associated conditions ( = .13), or infection-related ventilator-associated complications ( = .47). ETT suctioning plus scraping, compared to ETT suctioning alone, did not significantly improve the duration of mechanical ventilation, time to first successful SBT, length of hospital stay, and VAEs. These study findings do not support the routine use of ETT scraping for mechanically ventilated patients.