Technologic Advances in Endotracheal Tubes for Prevention of Ventilator-Associated Pneumonia

Abstract

231V entilator-associated pneumonia (VAP) is a common complication in patients on mechanical ventilation (MV). Depending on the surveillance methods used for the diagnosis of VAP, the risk of this complication ranges from 1.2 to 8.5 cases per 1,000 ventilatordays (0.6%-4%). 1 VAP is associated with increased hospital length of stay, mortality, infections due to multidrug-resistant pathogens, and an attributable hospital cost of approximately $10,000 to $25,000. 2,3 Therefore, preventive measures that could impact the incidence of VAP in the ICU setting must be considered a priority, because they could improve the safety of patients in the ICU. Multiple interventions are used to prevent VAP; however, there is a growing interest in those interventions related to the endotracheal tube (ETT) as one of the main targets linked to VAP. 2,4 An ETT tube is considered one of the major risk factors for VAP, acting both as a reservoir for potential infecting microorganisms and as a bridge between the oropharyngeal environment and the sterile bronchoalveolar space by bypassing host defenses. 5,6 Moreover, the ETT alters the ability of the host to clear secretions by coughing, and keeps the epiglottis open, allowing the passage of secretions and fluids into the airways.The two most important mechanisms implicated in the development of VAP are microaspiration and biofi lm formation. Microaspiration occurs when there is distal migration of microorganisms present in the secretions accumulated above the ETT cuff. 7 Biofi lm

Microbial Biofilms in Pulmonary and Critical Care Diseases

“…As with vascular catheters, strategies that incorporate materials into endotracheal tube biomaterials to inhibit bacterial adhesion and/or biofilm formation have been tested clinically (113). Most promising and extensively studied, silvercoated endotracheal tubes are associated with significantly reduced biofilm formation, bacterial lung colonization, and risk of ventilator-associated pneumonia (114,115).…”

Impact of Early Interventions by a Cardiac Rehabilitation Team on the Social Rehabilitation of Patients Resuscitated from Cardiogenic Out-of-hospital Cardiopulmonary Arrest

“…Regarding major complications, the incidence of respiratory complications was significantly lower in the late group. Although this is also largely attributable to benefits derived from the aforementioned advances in medical care, there are many studies describing the usefulness of physical therapy for patients maintained on mechanical ventilators (14,15). It is plausible that this low incidence of complications may be the consequence of the involvement of PT as members of the CR team practicing their specialized skills (such as the training of respiratory muscles and evaluation of swallowing function) in acute phase treatment.…”

Endotracheal Tubes: Old and NewDiscussion

“…96,97 Significant effort is being placed on redesigning the ETT to reduce the incidence of VAP. 11,86,[98][99][100][101] Efforts can be categorized as those that might reduce microaspiration and those that might reduce biofilm, in essence preventing bacteria from entering around the tube or through it. 99,100 Reducing the Impact of Microaspiration Design efforts in this area have focused primarily on blocking leakage of subglottic secretions and reducing the volume and virulence of these secretions.…”