Evaluation of Endotracheal Tube Scraping on Duration of Mechanical Ventilation and Ventilator-Associated Events

Abstract

Background:

Endotracheal tube (ETT) scraping or sweeping refers to the removal of secretions and biofilm inside of an ETT that can increase airway resistance. Currently, data is limited regarding the impact of ETT scraping on patient outcomes. Thus, we sought to evaluate the effect of ETT scraping on time to the first successful spontaneous breathing trial (SBT), duration of mechanical ventilation (MV), hospital length of stay, and occurrence of ventilator-associated events (VAEs).

Methods:

This was a single-center randomized clinical trial of adult subjects intubated between October 2019 and October 2021. Subjects were randomly assigned to either ETT suctioning via standard in-line suction catheter (control group) or ETT suctioning and scraping via a suction catheter with balloon sweeping technology (experimental group). Randomization occurred within 24 hours after intubation. Airway suctioning was performed as clinically indicated and ETT was scraped every time a respiratory therapist suctioned the patient. The primary outcome was time to the first successful SBT (defined as the ability to tolerate 30 mins SBT with RSBI < 105). Secondary outcomes were duration of MV, hospital length of stay, and occurrence of VAE. Intent to treat statistical analysis was performed. IRB approval was obtained.

Results:

Of 272 randomized subjects, the median age was 63 (IQR 52-73) years, 143 (53%) were males, and 154 (57%) had a primary diagnosis of acute respiratory failure. There was no significant difference between the study groups in median time (hours) to the first successful SBT [46.7 (IQR 29-87) vs 45.7 (IQR 27-95), P = .83]. There were no significant differences between the groups in duration of MV (P = .82), hospital length of stay (P = .74), the incidences of ventilator-associated conditions (P = .13), or infection-related ventilator-associated complications (P = .47).

Conclusions:

Among adults receiving mechanical ventilation, the use of ETT suctioning plus scraping, compared to ETT suctioning alone, did not significantly improve the time to successful SBT, duration of mechanical ventilation, or length of hospital stay. These study findings do not support the routine use of ETT scraping for mechanically ventilated patients.