Technological advances for prevention of biofilm in endotracheal tubes

Abstract

One of the mechanisms implicated in the development of ventilator-associated pneumonia (VAP) is biofilm formation in the endotracheal tube. Biofilm can be dislodged during aspirations and transferred to the sterile bronchial tract. Silver has an effective broad-spectrum antimicrobial activity. Silver-coated endotracheal tubes are well-tolerated, even in patients intubated for several days. This device has been shown to block biofilm formation in both animal and human studies. However, a clear decrease in lung colonization has only been observed in animals. To date, only one randomized multicenter human study has shown a decrease in VAP incidence in patients intubated with silver-coated tubes. However, neither ventilation duration nor mortality rate have been consequently reduced. This study is still debated and silver-coated endotracheal tubes not recommended to prevent VAP. Other technological interventions including the use of mucus shaver, mucus slurper, and biofilm photodynamic therapy have been shown efficient to reduce endotracheal tube biofilm; however they are still under evaluation.