Efficacy Study of a Novel Device to Clean the Endotracheal Tube
The purpose of this study is to evaluate the in-vivo efficacy of a novel device (endOclear) for cleaning the endotracheal tube (ETT) lumen from secretions. The investigators hypothesize that a protocol of routine ETT cleaning with endOclear may increase the ETT luminal volume measured at extubation compared to the current standard of care. The device may therefore be clinically useful by better maintaining the ETT original function.
Device: ETT cleaning maneuver
|Study Design:||Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Prevention
|Official Title:||Endotracheal Tubes Cleaned With a Novel Mechanism for Secretions Removal|
- Endotracheal Tube endoluminal residual volume [ Time Frame: At extubation (An expected average of 5 days) ] [ Designated as safety issue: No ]Implementing an original technique by Thomas, et al. (Interscience Conference on Antimicrobial Agents and Chemotherapy. 2006, San Francisco,CA. ICAAC06-A-2966-ASM), the investigators will measure the size of the inner lumen of each ETT using a high definition Computed Tomography (CT) imaging of the extubated ETTs with subsequent reconstruction and analysis by use of dedicated software. The whole ETT will be analyzed through hig-definition CT slices, with detection of the plastic-mucus-air interfaces resulting in multiple measurement of the ETT cross-sectional area (CSA). The investigators will calculate the luminal residual air volume, the total volume of mucus and all the associated measurements, such as lowest CSA. Comparing the volume of the used ETT to a blank clean same-size one, the investigators will also measure the relative loss of volume (%) due to mucus accumulation.
- ETT Microbiology [ Time Frame: At extubation (An expected average of 5 days) ] [ Designated as safety issue: No ]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) ] [ Designated as safety issue: No ]Samples of the ETT will be collected and stored in glutaraldehyde for subsequent Scanned Electron Microscopy (SEM) and Confocal Microscopy (CM) analysis.
- In-vivo respiratory mechanics [ Time Frame: Three times a day (An expected average of 5 days) ] [ Designated as safety issue: No ]Data about respiratory mechanics will be obtained in both groups for each enrolled patient three times a day (q8 hours). These measurements are safe non-invasive. They will require the RT to register pressure, volume and flow parameters from the ventilator in use on the patient.
- User's feedback [ Time Frame: At extubation (An expected average of 5 days) ] [ Designated as safety issue: Yes ]To evaluate the feasibility and efficacy of the endOclear, the investigators will administer an anonymous questionnaire to the RTs who will use the device during the study. RTs will be asked to evaluate the device on three clinical issues: efficacy in cleaning the ETT of the endOclear, safety of the new maneuver, and feasibility for future intensive care unit implementation. Nurses assisting the procedure will be asked for their anonymous opinion too. Outside of this final survey, users will be instructed to timely report to the investigators any concern regarding safety of the device or adverse events.
- ETT weight gain [ Time Frame: At extubation (An expected average of 5 days) ] [ Designated as safety issue: No ]Weight gain of the ETT due to secretions will be measured by mean of a high precision laboratory scale.
|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.
|United States, Massachusetts|
|Massachusetts General Hospital|
|Boston, Massachusetts, United States, 02114|
|Principal Investigator:||Robert M Kacmarek, PhD, RRT||Massachusetts General Hospital|