Objective: We evaluated a new device designed to clean the endotracheal tube in mechanically ventilated patients, the Mucus Shaver.
Design: Prospective, randomized trial.
Setting: University hospital intensive care unit.
Patients: We enrolled 24 patients expected to remain ventilated for >72 hrs.
Interventions: The Mucus Shaver is a concentric inflatable catheter for the removal of mucus and secretions from the interior surface of the endotracheal tube. The Mucus Shaver is advanced to the distal endotracheal tube tip, inflated, and subsequently withdrawn over a period of 3–5 secs. Patients were prospectively randomized within 2 hrs of intubation to receive standard endotracheal tube suctioning treatment or standard suctioning plus Mucus Shaver use until extubation.
Measurements and Main Results: During the study period, demographic data, recent medical history, adverse events, and staff evaluation of the Mucus Shaver were recorded. At extubation, each endotracheal tube was removed, cultured, and analyzed by scanning electron microscopy. Twelve patients were assigned to the study group and 12 were assigned to the control group. No adverse events related to the use of the Mucus Shaver were observed. At extubation, only one endotracheal tube from the Mucus Shaver group was colonized, whereas in the control group ten endotracheal tubes were colonized (8% vs. 83%; p < .001). Scanning electron microscopy showed little secretions on the endotracheal tubes from the study group, whereas thick bacterial deposits were present on all the endotracheal tubes from the control group (p < .001 by Fisher exact test, using a maximum biofilm thickness of 30 μm as cut-off). The nursing staff was satisfied by the overall safety, feasibility, and efficacy of the Mucus Shaver.
Conclusions: The Mucus Shaver is a safe, feasible, and efficient device for endotracheal tube cleaning in the clinical setting. The Mucus Shaver is helpful in preventing endotracheal tube colonization by potentially harmful microorganisms.
From the Department of Anesthesia, Critical Care, and Pain Medicine (LB, AC, EAB), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Experimental Medicine (AC, AP), University of Milan-Bicocca, Milan, Italy; Section of Pulmonary and Cardiac Assist Devices (TK), Pulmonary Critical Care Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Electron Microscopy Laboratory (PL), University of Reims Champagne Ardenne, INSERM, Reims, France; Department of General Surgery (JRP), University of Michigan, Ann Arbor, Michigan; Microbiology and Virology Department (SB), San Gerardo Hospital, Monza, Italy; Cardiovascular and Pulmonary Branch (JM), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Department of Perioperative Medicine and Intensive Care (AP), San Gerardo Hospital, Monza, Italy.
* See also p. 320.
This study was performed in the Intensive Care Unit of the Department of Perioperative Medicine and Intensive Care at San Gerardo Hospital, Monza, Italy, whereas microscopy was performed at the Electron Microscopy Laboratory of the University of Reims, Reims, France.
Supported, in part, by the National Heart, Lung, and Blood Institute, Division of International Research, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, and by the Department of Perioperative Medicine and Intensive Care, San Gerardo Hospital, Monza, Italy. Dr. Moss and Dr. Kolobow were supported by the Intramural Research Program, National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
Dr. Moss is an employee of the NIH. The remaining authors have not disclosed any potential conflicts of interest.
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