Decreasing Duration of Mechanical Ventilation With the Use of an Airway Clearance Device

Abstract

Background:

During mechanical ventilation (MV), management of the critical patient can be a challenge in the intensive care unit (ICU). Complications include an increased amount of secretions adhering to the endotracheal tube (ETT), which causes higher peak inspiratory pressures (PIP) and airway resistance (RAW), making it difficult for patients to tolerate weaning from MV. ETT suctioning can be ineffective, leaving residual biofilm. The presence of biofilm may cause increased airway resistance and lead to longer duration of MV. The endOclear Restore device purpose is to remove ETT secretions quickly and efficiently.

Purpose:

The objective of this study was to determine any benefits of the endOclear Restore device to minimize biofilm formation, maintain airway patency, and decrease ventilation days.

Methods:

This was an IRB exempt, 2-year retrospective, observational single center study to evaluate the efficacy of cleaning the ETT with endOclear Restore after ETT suctioning and oral care has been completed. Ventilation day data was collected prior to using endOclear on 374 subjects and post data on 336 subjects. Subjects were admitted into our adult Medical/Surgical/Neuro ICU, intubated with an ETT, and mechanically ventilated. Exclusion criteria included patients admitted for coronary artery bypass grafting, valve replacement, tracheostomy, and patients younger than 18 years of age. The measurements obtained before and after cleaning the ETT were PIP (362 observations) and Raw (352 observations). The paired t-Test was used to compare sample means.

Results:

Data from this 2-year study revealed that the average duration of MV decreased from 2.85 to 2.42 days (0.43 ± 1.58, p < 0.01), PIP was decreased from 26. 2 to 24.9 cm H₂O (1.3 ± 3.9, p < 0.01) and RAW was decreased from 17. 3 to 15.8 cm H₂O/L/s (1.5 ± 4. 2, p < 0.01) with the use of endOclear. Data is presented as mean ± SD.

Conclusions:

This study revealed that cleaning the ETT using the endOclear Restore device, after ETT suctioning and oral care had already been completed, significantly reduced the average duration of MV. The removal of adherent secretions/residual biofilm also dramatically decreased PIP and RAW and assisted in decreasing the work of breathing.

Parameter	Before	After
Average Duration of MV	2.85	2.42
PIP	26.2	24.9
RAW	17.3	15.8