Artificial airways provide both opportunities and challenges to clinicians concerned with airway clearance. For example, the artificial airway provides direct access to the lower airways for catheter suctioning of secretions and a direct route for lung instillation of medications that promote secretion mobilization. At the same time, the presence of an artificial airway impairs natural mechanisms of airway clearance-coughing and mucociliary function. Artificial airways are invariably coated with an antibiotic-resistant bacterial biofilm that can be introduced into the lung by several commonly applied airway clearance techniques. This factor is rarely considered during research on airway clearance techniques for patients with artificial airways. This review summarizes current research on airway clearance techniques for patients with artificial airways, with special attention to the implications of the bacterial biofilm. Directions for future research are also discussed.
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