Beware the siren’s song of novel endotracheal tube designs

Excerpt

Ventilator-associated pneumonia (VAP) remains a common and morbid complication of mechanical ventilation. Notwithstanding hospitals’ and device manufacturers’ extensive efforts to prevent this condition, clinical audits suggest VAP rates have changed little over the past decade [1]. VAP’s persistence compels us to redouble our efforts to find better ways to prevent this condition. Prevention efforts to date can be divided into two major domains: (1) technical innovations to reduce biofilm accumulation and passage of secretions around the endotracheal tube cuff, and (2) adaptive work to minimize duration of mechanical ventilation and thus time at risk for VAP. Examples of technical innovations include antiseptic-coatings, subglottic secretion drainage, tracheal cuff pressure maintenance systems, and novel endotracheal tube cuff designs. Examples of adaptive efforts include minimizing sedation, increasing the use of spontaneous awakening and spontaneous breathing trials, and early mobilization programs. …