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  • Title: Evaluation of Endotracheal Tube Scraping on Airway Resistance.
    Author: Scott JB, Dubosky MN, Vines DL, Sulaiman AS, Jendral KR, Singh G, Patel A, Kaplan CA, Gurka DP, Balk RA.
    Journal: Respir Care; 2017 Nov; 62(11):1423-1427. PubMed ID: 28790149.
    Abstract:
    BACKGROUND: Spontaneous breathing trials (SBTs) are used to assess the readiness for discontinuation of mechanical ventilation. When airway resistance (Raw) is elevated, the imposed work of breathing can lead to prolongation of mechanical ventilation. Biofilm and mucus build-up within the endotracheal tube (ETT) can increase Raw. Scraping the ETT can remove the biofilm build-up and decrease mechanical Raw. The primary aim of this study was to evaluate the impact of ETT scraping on Raw. The secondary aim was to determine whether decreasing Raw would impact subsequent SBT success. METHODS: Intubated, mechanically ventilated subjects were enrolled if they failed an SBT and had an Raw of > 10 cm H2O/L/s. SBT failure was based on institutional guidelines, and Raw was calculated by subtracting the difference between the measured peak and plateau pressures using a square flow waveform with an inspiratory flow set at 60 L/min. The endOclear device was inserted into the ETT and withdrawn per manufacturer's guidelines. Scraping was repeated until the ETT was cleared. Change in Raw was compared pre- and post-ETT scraping using a paired t test. A Mann-Whitney U test evaluated the difference in percentage change in Raw between SBT groups. RESULTS: Twenty-nine subjects completed the study. The mean pre- and post-ETT scraping Raw values were 15.17 ± 3.83 and 12.05 ± 3.19 cm H2O/L/s, respectively (P < .001). Subsequent SBT success was 48%; however, there was no difference in percentage change in Raw between subsequent passed SBT (18.61% [interquartile range 8.90-33.93%]) and failed SBT (23.88% [interquartile range 0.00-34.80%]), U = 78.5, z = -0.284, P = .78. No adverse events were noted with ETT scraping. CONCLUSIONS: This study demonstrated that ETT scraping can reduce Raw. The decrease in Raw post-ETT scraping did not affect subsequent SBT success.
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