RT Journal Article
SR Electronic
T1 <span hwp:id="article-title-1" class="article-title">Endotracheal Tubes: Old and New</span><span hwp:id="article-title-194" class="sub-article-title">Discussion</span>
JF Respiratory Care
FD American Association for Respiratory Care
SP 933
OP 955
DO 10.4187/respcare.02868
VO 59
IS 6
A1 Carl F Haas
A1 Richard M Eakin
A1 Mark A Konkle
A1 Ross Blank
YR 2014
UL http://rc.rcjournal.com/content/59/6/933.abstract
AB The development and evolution of the endotracheal tube (ETT) have been closely related to advances in surgery and anesthesia. Modifications were made to accomplish many tasks, including minimizing gross aspiration, isolating a lung, providing a clear facial surgical field during general anesthesia, monitoring laryngeal nerve damage during surgery, preventing airway fires during laser surgery, and administering medications. In critical care management, ventilator-associated pneumonia (VAP) is a major concern, as it is associated with increased morbidity, mortality, and cost. It is increasingly appreciated that the ETT itself is a primary causative risk for developing VAP. Unfortunately, contaminated oral and gastric secretions leak down past the inflated ETT cuff into the lung. Bacteria can also grow within the ETT in biofilm and re-enter the lung. Modifications to the ETT that attempt to prevent bacteria from entering around the ETT include maintaining an adequate cuff pressure against the tracheal wall, changing the material and shape of the cuff, and aspirating the secretions that sit above the cuff. Attempts to reduce bacterial entry through the tube include antimicrobial coating of the ETT and mechanically scraping the biofilm from within the ETT. Studies evaluating the effectiveness of these modifications and techniques demonstrate mixed results, and clear recommendations for which modification should be implemented are weak. Discussion