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Postgraduate Education Corner |

Technologic Advances in Endotracheal Tubes for Prevention of Ventilator-Associated PneumoniaEndotracheal Tube Technologies

Juan F. Fernandez, MD; Stephanie M. Levine, MD, FCCP; Marcos I. Restrepo, MD, FCCP; for the Spanish Lung Failure Collaborative Group
Author and Funding Information

From the Department of Medicine (Drs Fernandez, Levine, and Restrepo), Division of Pulmonary and Critical Care Medicine, the University of Texas Health Science Center at San Antonio; and the Veterans Evidence Based Research Dissemination and Implementation Center (VERDICT) (Dr Restrepo), Audie L. Murphy VA Hospital, San Antonio, TX.

Correspondence to: Marcos I. Restrepo, MD, FCCP, Veterans Evidence Based Research Dissemination and Implementation Center (VERDICT), South Texas Veterans Health Care System ALMD, 7400 Merton Minter Blvd, San Antonio, TX 78229; e-mail: restrepom@uthscsa.edu

Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Restrepo participated on advisory boards for Janssen Pharmaceuticals, Inc; Theravance; Forest Laboratories; Johnson & Johnson; and Novartis AG. He is a former speaker for Covidien; C. R. Bard, Inc; Johnson & Johnson (Ortho-McNeil-Janssen); and Pfizer, Inc; and is a consultant for Theravance and Pfizer, Inc (Wyeth). Drs Fernandez and Levine have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Funding/Support: Dr Restrepo was funded partially by the National Heart, Lung, and Blood Institute [K23HL096054].


Funding/Support: Dr Restrepo was funded partially by the National Heart, Lung, and Blood Institute [K23HL096054].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(1):231-238. doi:10.1378/chest.11-2420
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Ventilator-associated pneumonia (VAP) is associated with high morbidity, mortality, and costs. Interventions to prevent VAP are a high priority in the care of critically ill patients requiring mechanical ventilation (MV). Multiple interventions are recommended by evidence-based practice guidelines to prevent VAP, but there is a growing interest in those related to the endotracheal tube (ETT) as the main target linked to VAP. Microaspiration and biofilm formation are the two most important mechanisms implicated in the colonization of the tracheal bronchial tree and the development of VAP. Microaspiration occurs when there is distal migration of microorganisms present in the secretions accumulated above the ETT cuff. Biofilm formation has been described as the development of a network of secretions and attached microorganisms that migrate along the ETT cuff polymer and inside the lumen, facilitating the transfer to the sterile bronchial tree. Therefore, our objective was to review the literature related to recent advances in ETT technologies regarding their impact on the control of microaspiration and biofilm formation in patients on MV, and the subsequent impact on VAP.


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