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The endotracheal tube (ETT) is a crucial medical device that allows life-sustaining respiratory support and protects the airway of critically ill patients. However, an ETT in the trachea disrupts the natural defense mechanism of physiological mucus clearance1 and results in the formation of biofilm and mucus on the intraluminal surface of the ETT.2
Biofilms are complex, flourishing microbial communities attached to surfaces and distributed in extracellular matrix.3 Biofilm plays a significant role in ventilator-associated pneumonia (VAP) pathophysiology. After intubation and ETT cuff inflation, secretions from the oropharynx that may contain pathogens responsible for VAP accumulate in the subglottic space above the cuff. These secretions are slowly aspirated into the lower respiratory tract due to microscopic folds on the outer surface of the ETT cuff.4 The biofilm formation inside an ETT, from attachment to the surface to release in the surrounding environment, can occur in < 96 h.5 Biofilm continues to grow and mature, allowing multiple bacterial species to attach to its matrix. The ETT surface becomes the perfect breeding ground for bacteria due to its optimal temperature, humidity, and constant flow of nutrients from the lower airways. The ETT surface also keeps biofilm from the body’s immune system and systemic antibiotic administration.4 The inspiratory flow through the ETT may create enough shear force to detach biofilm fragments and reach the lower respiratory tract.6
Endotracheal suctioning removes secretions in patients with an ETT and prevents obstruction. A flexible catheter is used to …
Correspondence: Christopher Piccuito MSEd RRT RRT-NPS RRT-ACCS, 55 Fruit Street, Blake 648, Boston, MA 02114. E-mail: cpiccuito{at}partners.org
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