• Andrea Coppadoro, Giacomo Bellani, Alfio Bronco, Alberto Lucchini, Simone Bramati, Vanessa Zambelli, Roberto Marcolin, and Antonio Pesenti.
• Department of Health Science, University of Milan-Bicocca, Via Cadore 48, Monza (MB), 20900, Italy. andrea.coppadoro@gmail.com.
• Ann Intensive Care. 2015 Dec 1; 5 (1): 57.

BackgroundEarly after intubation, a layer of biofilm covers the inner lumen of the endotracheal tube (ETT). Cleaning the ETT might prevent airways colonization by pathogens, reduce resistance to airflow, and decrease sudden ETT obstruction. We investigated the effectiveness of a cleaning closed suction system in maintaining the endotracheal tube free from secretions.MethodsWe conducted a single center, randomized controlled trial, in the general intensive care unit of a tertiary-level university hospital. We enrolled 40 adult critically ill patients expected to remain intubated for more than 48 h, within 24 h from intubation. Patients were randomized to receive three ETT cleaning maneuvers/day using a novel device (Airway Medix Closed Suction System™, cleaning group) or to standard care (no ETT cleaning, standard closed suction, control group). After extubation, the amount of secretions in the ETTs was measured by micro-computed tomography.ResultsThe volume of secretions in the ETTs from the cleaning group was lower than controls (0.081 [0.021-0.306] vs. 0.568 [0.162-0.756] mL, p = 0.001), corresponding to a cross-sectional area reduction six times lower (1[0-3] vs. 6 [2-10] %, p = 0.001). In a subset of 16 patients, the resistance to airflow tended to be lower after 1 day of treatment (p = 0.063) and was lower after 2 days (0.024), while no difference was present at enrollment (p = 0.922). ETT colonization did not differ between the two groups.ConclusionsThe use of a novel cleaning closed suction system proved to be effective in reducing secretions present in the ETT after extubation, possibly reducing resistance to airflow during intubation.Trial Registrationclinicaltrials.gov NCT01912105.

3 keywords...

hide…