Efficacy Study on Silver-coated ETT Cleaned With a Novel Device

• ClinicalTrials.gov Identifier: NCT02120001
• Recruitment Status: Completed
• First Posted: April 22, 2014
• Results First Posted: May 19, 2017
• Last Update Posted: May 19, 2017
• Sponsor: Massachusetts General Hospital
• Collaborators: Brigham and Women's Hospital; Rhode Island Hospital
• Information provided by (Responsible Party): Robert M. Kacmarek, Massachusetts General Hospital

Study Description

Brief Summary:

The purpose of this study is to test the efficacy of a novel cleaning device in keeping silver-coated endotracheal tubes free from bacterial colonization.

Condition or disease	Intervention/treatment	Phase
Ventilator Associated Pneumonia; Critically Ill	Device: ETT cleaning maneuver	Not Applicable

Detailed Description:

Several studies have suggested that biofilm formation inside the ETT plays a pivotal role in VAP development and drug-resistance induction. Silver-coated ETT have proven effective in delaying but not in preventing ETT colonization and biofilm formation, due to a barrier effect of biofilm and accumulated debris. Advanced ETT cleaning devices are able to remove debris and biofilm and reduce the total ETT microbial load to a certain extent. The Investigators hypothesize that the routine use of endOclear in patients intubated with a silver-coated ETT will reduce ETT microbial colonization. The Investigators therefore want to assess the reduction of ETT microbial colonization in patients intubated with a silver-coated ETT and cleaned with endOclear compared to the current standard of care of silver-coated ETT (blind suctioning). They plan to achieve this result by analyzing the tubes of each enrolled patient after it has been removed, either because the patient does not need it anymore due to his/her better clinical conditions, or because there is a need of tracheostomy or because he/she dies. Specifically they will analyze how the endOclear cleaning maneuver affects microbial colonization in the inner layer of the ETT and how this can determine distal airway inoculation and, ultimately, VAP development.

Specific AIM #1: Investigators will test the hypothesis that routine use of endOclear in patients intubated with a silver-coated ETT will reduce ETT microbial colonization.

Specific AIM #2: Investigators will test the hypothesis that keeping ETTs free from microbial colonization will prevent septic inoculation of distal airways

Specific AIM #3: Investigators will test the hypothesis that prevention of ETT biofilm development will reduce drug resistance rates found in ETT and distal airways isolates

The investigators will conduct a randomized clinical trial on 40 patients intubated with silver-coated ETT and randomized to receive standard ETT cleaning vs cleaning with the endOclear device.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 40 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Single (Outcomes Assessor)
• Primary Purpose: Prevention
• Official Title: Silver-coated Endotracheal Tube Cleaned With a Novel Mechanism for Secretion Removal: a Randomized Controlled Clinical Study.
• Study Start Date: June 2014
• Actual Primary Completion Date: August 2015
• Actual Study Completion Date: August 2015

Arms and Interventions

Arm	Intervention/treatment
Experimental: ETT cleaning maneuver; 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; EndOclear 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. 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.; Other Name: endOclear
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.

Outcome Measures

Primary Outcome Measures :

1. Endotracheal Tube Colonization [ Time Frame: At extubation (an expected average of 7 days) ]
   Discarded ETTs will be collected after extubation and sent for quantitative and qualitative microbiological analysis after silver ion inactivation. Qualitative analysis was based on confocal microscopy, we described visually the distribution of microbial colonization. However, we did not report numerical value because the confounding factors (i.e., number and length of devices).

Secondary Outcome Measures :

1. Microbiological Colonization of Distal Airways [ Time Frame: At extubation (An expected average of 7 days) ]
   Investigators will collect data about distal airways samples performed for clinical reasons during the study period and, in addition, investigators will collect a specimen from the distal airways immediately before extubation.

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Admission to Medical, Surgical or Neuro ICU
• Subjects must be enrolled within 24 hours from intubation
• Subjects expected to be intubated for at least 48 hours or longer
• Subjects have been intubated with a silver-coated ETT

Exclusion Criteria:

• Current and past participation in another interventional trial conflicting with the present study
• Pregnant women
• Prisoner status

Contacts and Locations

Locations

United States, Massachusetts

Massachusetts General Hospital

Boston, Massachusetts, United States, 02114

Sponsors and Collaborators

Massachusetts General Hospital

Brigham and Women's Hospital

Rhode Island Hospital

Investigators

• Principal Investigator: Robert Kacmarek, PhD; Massachusetts General Hospital

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Pirrone M, Imber DA, Marrazzo F, Pinciroli R, Zhang C, Bry L, Delaney ML, Dubois AM, Thomas JG, Nistico L, Melton-Kreft R, Bittner EA, Kacmarek RM, Berra L. Silver-Coated Endotracheal Tubes Cleaned With a Mechanism for Secretion Removal. Respir Care. 2019 Jan;64(1):1-9. doi: 10.4187/respcare.06222. Epub 2018 Sep 4.

• Responsible Party: Robert M. Kacmarek, Anesthesia and Critical Care MD, Massachusetts General Hospital
• ClinicalTrials.gov Identifier: NCT02120001
• Other Study ID Numbers: DAN1000AM
• First Posted: April 22, 2014
• Results First Posted: May 19, 2017
• Last Update Posted: May 19, 2017
• Last Verified: April 2017

Keywords provided by Robert M. Kacmarek, Massachusetts General Hospital:

Medical Devices; Ventilator-Associated Pneumonia (VAP); Ventilator-Associated Events (VAE); Endotracheal Tube; Microbial Diversity; Drug-Resistance; biofilms; endotracheal intubation; mechanical ventilation

Additional relevant MeSH terms:

Pneumonia; Pneumonia, Ventilator-Associated; Critical Illness; Respiratory Tract Infections; Infections; Lung Diseases; Respiratory Tract Diseases; Disease Attributes; Pathologic Processes; Healthcare-Associated Pneumonia; Cross Infection; Iatrogenic Disease