Pinciroli Riccardo, Mietto Cristina, Piriyapatsom Annop, Chenelle Christopher T, Thomas John G, Pirrone Massimiliano, Bry Lynn, Wojtkiewicz Gregory R, Nahrendorf Matthias P, Kacmarek Robert M, Berra Lorenzo
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts.
Respir Care. 2016 Nov;61(11):1431-1439. doi: 10.4187/respcare.04363. Epub 2016 Jul 26.
Intubation compromises mucus clearance, allowing secretions to accumulate inside the endotracheal tube (ETT). The purpose of this trial was to evaluate a novel device for ETT cleaning. We hypothesized that its routine use would reduce tube occlusion due to mucus accumulation, while decreasing airway bacterial colonization.
Subjects were randomized to either the use of the device every 8 h, or the institutional standard of care (blind tracheal suction) only. ETTs were collected at extubation and analyzed with high-resolution computed tomography (HRCT) for quantification of mucus volume. Microbiological testing was performed on biofilm samples. Vital signs and ventilatory settings were collected at the bedside. In-hospital follow-up was conducted, and a final evaluation survey was completed by respiratory therapists.
Seventy-four subjects expected to remain intubated for longer than 48 h were enrolled (77 ETTs, 37 treatment vs 40 controls). Treated tubes showed reduced mucus accumulation (0.56 ± 0.12 vs 0.71 ± 0.28 mL; P = .004) and reduced occlusion (6.3 ± 1.7 vs 8.9 ± 7.6%; P = .039). The HRCT slice showing the narrowest lumen within each ETT exhibited less occlusion in cleaned tubes (10.6 ± 8.0 vs 17.7 ± 13.4%, 95% CI: 2-12.1; P = .007). Data on microbial colonization showed a trend in the treatment group toward a reduced ETT-based biomass of bacteria known to cause ventilator-associated pneumonia. No adverse events were reported. The staff was satisfied by the overall safety and feasibility of the device.
The endOclear is a safe and effective device. It prevents luminal occlusion, thereby better preserving ETT nominal function.
气管插管会影响黏液清除，导致分泌物在气管内导管（ETT）内积聚。本试验的目的是评估一种用于ETT清洁的新型装置。我们假设其常规使用将减少因黏液积聚导致的导管阻塞，同时减少气道细菌定植。
受试者被随机分为每8小时使用该装置组或仅采用机构护理标准（盲法气管吸引）组。在拔管时收集ETT，并通过高分辨率计算机断层扫描（HRCT）分析以定量黏液量。对生物膜样本进行微生物检测。在床边收集生命体征和通气设置。进行院内随访，并由呼吸治疗师完成最终评估调查。
纳入了74名预计插管时间超过48小时的受试者（77根ETT，37根治疗组 vs 40根对照组）。接受治疗的导管显示黏液积聚减少（0.56±0.12 vs 0.71±0.28 mL；P = 0.004），阻塞减少（6.3±1.7 vs 8.9±7.6%；P = 0.039）。显示每个ETT内最窄管腔内径的HRCT切片显示，清洁后的导管阻塞较少（10.6±8.0 vs 17.7±13.4%，95% CI：2 - 12.1；P = 0.007）。微生物定植数据显示，治疗组中已知导致呼吸机相关性肺炎的基于ETT的细菌生物量有减少趋势。未报告不良事件。工作人员对该装置的整体安全性和可行性感到满意。
EndOclear装置安全有效。它可防止管腔阻塞，从而更好地保持ETT的标称功能。
