Antibacterial-coated tracheal tubes cleaned with the Mucus Shaver: a novel method to retain long-term bactericidal activity of coated tracheal tubes

Objective: To assess the long-term benefit from antibacterial coatings of the tracheal tube (ETT), and to keep clean the lumen of the ETT. Design: Experimental animal study. Setting: USA National Institutes of Health. Subjects: Twelve sheep. Interventions: Twelve ETTs were internally dip-coated with a silver-sulfadiazine in polyurethane. We developed a concentric inflatable silicone rubber "razor", the Mucus Shaver (MS), to shave the ETT lumen free of mucus. In a single pass, we cleaned all mucus from the internal surface of the ETT. Control group: Five intubated sheep were mechanically ventilated for 72 h. The ETT was suctioned every 6 h. Study group: Six sheep were intubated and mechanically ventilated for 72 h. The ETT was suctioned and cleaned with the MS every 6 h. An additional sheep was intubated and mechanically ventilated for 168 h. Bacteriologic studies and scanning electron microscopy were performed to assess bacterial colonization and thickness of secretions on the internal surface of the ETT. Measurements and main results: In the control group, the ETT was always heavily colonized: median debris thickness was 380 μm, range 270-550 μm. In the study group, there was no colonization and no secretions in the ETT, except for three ETT that were colonized solely at the very tip. Conclusions: Silver-based coating of ETT cleaned with the MS every 6 h significantly reduces accumulation of mucus/secretion and bacterial growth within the ETT following 72 h of mechanical ventilation.