Efficacy Study of a Novel Device to Clean the Endotracheal Tube

Learning Objectives: Intubation compromises mucus clearance and secretions accumulate inside the endotracheal tube (ETT). Purpose of this randomized con- trolled study is to clinically evaluate the efficacy of the Endoclear®, a novel device for ETT cleaning, to reduce tube occlusion due to mucus accumulation while decreasing airway bacterial colonization. Methods: e Endoclear is a sterile, single-use catheter with a wiping apparatus at its distal end. Once in position, the cleaning device is expanded, and then withdrawn from the tube, thereby removing endoluminal debris. Patients were randomized to either the use of the device every 8 hours or blind suctioning through a closed system (control group). ETTs were collected at extubation, and subsequently analyzed with High- Resolution Computed Tomography for quantification of endoluminal mucus volume. Bacterial and fungal cultures were obtained from samples of endolu- minal biofilm collected through bath sonication of the whole mucus content in each ETT. An evaluation survey was also submitted to the involved Respiratory erapists. Results: 74 patients expected to remain intubated for more than 48 hours were enrolled for a total of 76 ETTs (37 vs 39 controls) analyzed. Average luminal occlusion ratio was significantly lower in the treated ETTs (mucus/total tube volume %ml: 6.3 ± 1.7 vs 8.9 ± 7.6; p=0.04). e analysis of slice-by-slice cross-sectional area also yielded significant results, particularly comparing the point of maximum occlusion within each tube (mucus/total slice area %mm2: 17.7 ± 13.4% vs 10.6 ± 8.0, control vs treatment; p<0.01). Microbial colonization showed a trend in the treatment group towards a lower risk to isolate bacteria known as ventilator-associated pneumonia causatives. No adverse events were eported. e staff was satisfied by the overall safety, efficacy and feasibility of the device. Conclusions: e Endoclear is a safe and clinically effective device for ETT cleaning. It prevents luminal tube occlusion, thereby preserving the ETT nominal function better than the current standard of care.