Silver-Coated Endotracheal Tubes Cleaned With a Mechanism for Secretion Removal

• Published in: Respiratory care Vol. 64; no. 1; pp. 1 - 9
• Main Authors: Pirrone, Massimiliano, Imber, David Ae, Marrazzo, Francesco, Pinciroli, Riccardo, Zhang, Changsheng, Bry, Lynn, Delaney, Mary L, Dubois, Andrea M, Thomas, John G, Nistico, Laura, Melton-Kreft, Rachael, Bittner, Edward A, Kacmarek, Robert M, Berra, Lorenzo
• Format: Journal Article
• Language: English
• Published: United States Daedalus Enterprises, Inc 01.01.2019; Daedalus Enterprises Inc
• Subjects: Aged; Biofilms - growth & development; Complications and side effects; Development and progression; Editor's Choice; Equipment Contamination - prevention & control; Female; Humans; Intratracheal intubation; Intubation, Intratracheal - instrumentation; Male; Middle Aged; Pneumonia, Ventilator-Associated - microbiology; Pneumonia, Ventilator-Associated - prevention & control; Respiration, Artificial - instrumentation; Risk factors; Silver; Suction - methods; Trachea - metabolism; Trachea - microbiology; Ventilator-associated pneumonia; airway obstruction; pneumonia; airway management; ventilation; intubation; ventilator-associated pneumonia; biofilms
• ISSN: 0020-1324; 1943-3654
• DOI: 10.4187/respcare.06222

Biofilm on the surface of endotracheal tubes (ETTs) is associated with ventilator-associated pneumonia. The use of silver-coated ETTs has been suggested to reduce the occurrence of ventilator-associated pneumonia by preventing biofilm formation. However, mucus accumulation can reduce the antibacterial activity of silver-coated ETTs by isolating bacterial colonies from the silver surface. We hypothesized that, in mechanically ventilated subjects, periodic removal of secretions through the use of a cleaning device would enhance the antimicrobial properties of silver-coated ETTs and thus reduce bacterial colonization. Subjects were randomized to either standard suctioning (blind tracheal suctioning, control group) or blind tracheal suctioning plus cleaning maneuver every 8 h (treatment group). Tracheal aspirates were collected immediately before extubation for microbiological culture. After extubation, ETTs were collected for both cultural and non-cultural microbiological analysis and biofilm isolation. 39 subjects expected to be ventilated for > 48 h were enrolled; 36 ETTs (18 control, 18 treatment) and 29 tracheal samples (15 control, 14 treatment) were collected. Among the ETTs positive for bacterial colonization (15 vs 9, = .18), cleaning maneuvers did not reduce microbial load, shown as the decimal logarithm of colony-forming units (CFU) per mL (1.6 ± 1.2 vs 0.9 ± 1.2 logCFU/mL, = .15). There was a trend toward decreased biofilm deposition (439.5 ± 29.0 vs 288.9 ± 157.7 mg, = .09) in the treated ETTs. No significant differences were observed in the number of positive tracheal aspirates (13 vs 10, = .39) or in the microbial load (4.8 ± 4.0 vs 4.2 ± 3.8 logCFU/mL, = .70) of tracheal secretions. Finally, no differences in the microbial load of Gram-positive organisms, Gram-negative organisms, or yeasts were found between the ETTs and tracheal aspirates of the 2 groups. In 39 critically-ill subjects intubated with silver-coated ETTs, periodic cleaning maneuvers did not decrease bacterial colonization of the ETTs and did not lower respiratory tract colonization compared to the standard suctioning. (Clinicaltrials.gov registration NCT02120001.).