Prevention of Endotracheal Tube Biofilm Formation in Intubated Critically Ill Patients

Endotracheal tubes (ETT) of intubated patients are constantly challenged with abundant bacteria-laden secretions. Quickly those bacteria may organize in a well-organized structure (biofilm) which is difficult to eradicate. Fragments can detach spontaneously or become dislodged by suction catheters and enter the lungs representing a source of infection. Recently several strategies have been developed to prevent bacterial biofilm formation and secretion accumulation. In this review we summarized published studies on ETT-biofilm prevention. Numerous antimicrobial-impregnated ETT have been designed to provide either bactericidal/static properties, or to prevent adhesion of bacteria on its surface. In vitro experiments and animal-studies showed several success rates in the prevention of bacterial colonization of the tube. Up to now, only two coatings, silver-hydrogel and silver-sulfadiazine in polyurethane, have been tested in clinical trials. Both proved to prevent/lower bacterial colonization of the ETT, while only the silver-hydrogel coating decreased bacterial colonization of lungs in a large multicenter study. Another innovative approach is to reduce contaminated-secretions in the ETT-lumen with novel medical devices designed to retrieve accumulated-mucus from the ETT/trachea. The mucus shaver and the mucus slurper are intended to reduce loaded-bacteria secretions from within the ETT/trachea. While experimental studies are promising, no clinical trials have been performed yet to prove this novel concept.