Antimicrobial materials for endotracheal tubes: A review on the last two decades of technological progress

Co-immobilization of ciprofloxacin and chlorhexidine as a long-term, broad-spectrum antimicrobial dual-drug coating for polyvinyl chloride (PVC)-based endotracheal tubes

“…Preventing microbial colonization has long been recognized as the best approach to avoid biofilm formation and thus, VAP. In the last few decades, technology has advanced, although at a slow pace, regarding the development of new active and/or passive materials for improving ETT surfaces [19]. This relatively slow pace has been shown not to be attributable to a shortage of new ideas, as recently evidenced [19], but to the challenge of overcoming fundamental hurdles associated with VAP (e.g., persistent colonization/biofilm formation; mechanical ventilation time; ICU length of stay; VAP occurrence).…”

“…In the last few decades, technology has advanced, although at a slow pace, regarding the development of new active and/or passive materials for improving ETT surfaces [19]. This relatively slow pace has been shown not to be attributable to a shortage of new ideas, as recently evidenced [19], but to the challenge of overcoming fundamental hurdles associated with VAP (e.g., persistent colonization/biofilm formation; mechanical ventilation time; ICU length of stay; VAP occurrence). In addition, the design and implementation of new biomaterials often imply following specific criteria (e.g., antimicrobial activity; safety-to-use; longterm stability; surface physicochemical properties) to achieve clinical successfulness.…”

“…Biocompatibility, as well as stability, is another feature often dismissed in reports addressing antimicrobial materials for ETTs [19]. Despite the efforts that have been made to study both of these traits, data remain scant or controversial, thereby leading to inconclusive safety and clinical usefulness of most emergent ETT coatings.…”

“…; https://doi.org/10.1101/2023.04. 13.534541 doi: bioRxiv preprint antimicrobial and antifouling approaches, but most limitedly addressing antimicrobial activity and/or safety-of-use [19]. In addition, studies have proven insufficient in tackling polymicrobial ETT biofilms, an underappreciated issue with a significant fate for VAP.…”

Use of Biomaterials in Endotracheal Tubes: Perspective under Optica of Infectology

“…The infl ammatory process caused, generates above average secretions, and can evolve to laryngeal edema, ulcerations and vocal cord detriments, which makes this environment conducive to the proliferation of bacteria, both endogenous and exogenous. According to this scenario, the scientifi c literature warns about a direct relationship of mechanical ventilation with the genesis of injuries and infections, especially pneumonia, given that individuals submitted to the Orotracheal Intubation (OTI) process commonly enjoy this mechanism for a prolonged time [3].…”