Efficacy Study of a Novel Device to Clean the Endotracheal Tube
|Endotracheal Extubation Airway Obstruction Airway Control Pneumonia, Ventilator-Associated Breathing Mechanics||Device: ETT cleaning maneuver|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Outcomes Assessor
Primary Purpose: Prevention
|Official Title:||Endotracheal Tubes Cleaned With a Novel Mechanism for Secretions Removal|
- Percentage of Occlusion Assessed Using a High Definition Computed Tomography Imaging of the Extubated ETTs [ Time Frame: At extubation (An expected average of 5 days) ]The investigators will measure percentage of occlusion determined by the accumulation of secretion within the lumen of each ETT using a high definition Computed Tomography (CT) imaging of the extubated ETTs. The whole ETT will be analyzed through high-definition CT slices. 100% of occlusion means total occlusion of the lumen of the ETT and 0% means absence of any occlusion.
- ETT Microbiology [ Time Frame: At extubation (An expected average of 5 days) ]For each patient a quantitative culture will be obtained from the ETT after extubation. Secretions will be retrieved from the ETT after CT scan and quantitative standard cultures will be performed. Microbial molecular diversity analysis and antibacterial resistance patterns will also be studied.
- ETT Microscopic Imaging [ Time Frame: At extubation (An expected average of 5 days) ]Exploratory outcome include microscopy imaging of distribution of bacteria on the ETT surface.
- In-vivo Respiratory Mechanics [ Time Frame: During intubation ]Respiratory mechanics are exploratory data to evaluate respiratory function
- User's Feedback [ Time Frame: During intubation ]Questionnaires to healthcare provider were collected to evaluate the use of the device.
- ETT Weight Gain [ Time Frame: After extubation ]Gross weight of the ETT was measured at extubation, when possible.
|Study Start Date:||September 2012|
|Study Completion Date:||December 2013|
|Primary Completion Date:||December 2013 (Final data collection date for primary outcome measure)|
Experimental: ETT cleaning manuver
Patients randomized to the treatment group will undergo an ETT cleaning maneuver with endOclear three times a day (every 8 hours) for the whole intubation period in addition to the standard of care.
Device: ETT cleaning maneuver
The ETT cleaning maneuver will be performed through the endOclear device. This is a commercially available device. It consists of an endotracheal tube cleaning apparatus with a flexible central tube and a cleaning device at its distal end. The cleaning device has a mechanically expandable mesh structure which can be adapted to selectively move between a radially-collapsed position and a radially-expanded one. In operation, the collapsed cleaning apparatus is inserted into the ETT through a Y-shaped connector. The device is then expanded by a safety toggle protected trigger mechanism that, when fired, presses the device's smooth silicone disc against the inside surface of the endotracheal tube. The cleaning apparatus is then pulled out of the endotracheal tube removing mucus deposits and secretions.
We plan to add the use of endOclear to the standard ICU practice, scheduling the systematic use of the device every 8 hours for the whole intubation period.
No Intervention: Standard of care
In the protocol no intervention is planned for the control group, which will therefore be treated with blind suctioning as per caregiver clinical decision.
After a few days of mechanical ventilation (MV), the lumen of the endotracheal tube (ETT) is coated with a thick bacterial biofilm, which is a potential source for bacterial colonization of the lower respiratory tract and ventilator-associated pneumonia (VAP). Accumulation of mucus/secretions on the interior of the ETT also effectively lowers the cross section of the ETT and increases significantly the work of breathing in intubated patients, who then require increased MV support, with prolonged intubation and ICU stay.
A primary goal for all ICUs is to shorten the time of MV, to decrease the incidence of ETT microbial colonization and ultimately VAP incidence. To meet this goal several airways technologies to maintain the ETT free from debris/bacteria have been developed in order to improve the current ventilator-liberation standards in intubated critically ill patients.
Based on preliminary laboratory, animal and clinical data, The investigators now wish to test the hypothesis that a novel commercially available ETT cleaning device can be effective in targeting two specific issues:
- Specific aim 1: To evaluate the mean difference in ETT luminal volume of ETTs cleaned with the novel cleaning device (EndOclear) vs. ETT cleaned in the standard manner.
- Specific aim 2: To determine whether ETTs cleaned with the novel device show a lower degree of microbial colonization for the entire period of mechanical ventilation.
Data about in-vivo respiratory mechanics measurements, microbial diversity and antibiotic resistance analysis, users' feedbacks and safety of the device will also be collected.
The investigators will conduct a clinical trial on 74 intubated patients randomized to receive standard ETT cleaning or cleaning with the EndOclear.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01765530
|United States, Massachusetts|
|Massachusetts General Hospital|
|Boston, Massachusetts, United States, 02114|
|Principal Investigator:||Robert M Kacmarek, PhD, RRT||Massachusetts General Hospital|