Current Respiratory Medicine Reviews

Joseph Varon  
The University of Texas Health Science Center
Houston, TX
USA

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Prevention of Endotracheal Tube Biofilm Formation in Intubated Critically Ill Patients

Author(s): Lorenzo Berra, Asheesh Kumar.

Abstract:

Endotracheal tubes (ETT) of intubated patients are constantly challenged with abundant bacteria-laden secretions. Quickly those bacteria may organize in a well-organized structure (biofilm) which is difficult to eradicate. Fragments can detach spontaneously or become dislodged by suction catheters and enter the lungs representing a source of infection. Recently several strategies have been developed to prevent bacterial biofilm formation and secretion accumulation. In this review we summarized published studies on ETT-biofilm prevention. Numerous antimicrobial-impregnated ETT have been designed to provide either bactericidal/static properties, or to prevent adhesion of bacteria on its surface. In vitro experiments and animal-studies showed several success rates in the prevention of bacterial colonization of the tube. Up to now, only two coatings, silver-hydrogel and silver-sulfadiazine in polyurethane, have been tested in clinical trials. Both proved to prevent/lower bacterial colonization of the ETT, while only the silver-hydrogel coating decreased bacterial colonization of lungs in a large multicenter study. Another innovative approach is to reduce contaminated-secretions in the ETT-lumen with novel medical devices designed to retrieve accumulated-mucus from the ETT/trachea. The mucus shaver and the mucus slurper are intended to reduce loaded-bacteria secretions from within the ETT/trachea. While experimental studies are promising, no clinical trials have been performed yet to prove this novel concept.

Keywords: Biofilm, endotracheal tube, mechanical ventilation, ventilator associated pneumonia

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Article Details

VOLUME: 6
ISSUE: 1
Year: 2010
Page: [3 - 10]
Pages: 8
DOI: 10.2174/157339810790820403