A clinical assessment of the Mucus Shaver: a device to keep the endotracheal tube free from secretions

Abstract

Objective: : We evaluated a new device designed to clean the endotracheal tube in mechanically ventilated patients, the Mucus Shaver.

Design: : Prospective, randomized trial.

Setting: : University hospital intensive care unit.

Patients: : We enrolled 24 patients expected to remain ventilated for >72 hrs.

Interventions: : The Mucus Shaver is a concentric inflatable catheter for the removal of mucus and secretions from the interior surface of the endotracheal tube. The Mucus Shaver is advanced to the distal endotracheal tube tip, inflated, and subsequently withdrawn over a period of 3-5 secs. Patients were prospectively randomized within 2 hrs of intubation to receive standard endotracheal tube suctioning treatment or standard suctioning plus Mucus Shaver use until extubation.

Measurements and main results: : During the study period, demographic data, recent medical history, adverse events, and staff evaluation of the Mucus Shaver were recorded. At extubation, each endotracheal tube was removed, cultured, and analyzed by scanning electron microscopy. Twelve patients were assigned to the study group and 12 were assigned to the control group. No adverse events related to the use of the Mucus Shaver were observed. At extubation, only one endotracheal tube from the Mucus Shaver group was colonized, whereas in the control group ten endotracheal tubes were colonized (8% vs. 83%; p < .001). Scanning electron microscopy showed little secretions on the endotracheal tubes from the study group, whereas thick bacterial deposits were present on all the endotracheal tubes from the control group (p < .001 by Fisher exact test, using a maximum biofilm thickness of 30 μm as cut-off). The nursing staff was satisfied by the overall safety, feasibility, and efficacy of the Mucus Shaver.

Conclusions: : The Mucus Shaver is a safe, feasible, and efficient device for endotracheal tube cleaning in the clinical setting. The Mucus Shaver is helpful in preventing endotracheal tube colonization by potentially harmful microorganisms.

Figure 1. The “Mucus Shaver”

(A) Schematic representation of the Mucus Shaver. (B) Mucus Shaver inflation. (C) Mucus Shaver inflated after being introduced into an endotracheal tube. Shaped areas = silicon rubber. (Permission to reprint by Kolobow T, Anesthesiology 2005;102:1063-5).

Figure 2. Appearance of an acute occlusion of the ETT lumen

(A) Appearance of the inner lumen of an ETT after extubation from patients in the Mucus Shaver group intubated for 4 to 19 days. Note the absence of any mucus or secretion deposit. Note that even at the tip of the ETT, no secretions are apparent. (B) and (C) Higher magnification of ETTs in picture (A).

Figure 3. Scanning electron microscopy of ETT lumen at extubation

(A) and (B): Electron micrograph of the ETT lumen in a patient group in which the Mucus Shaver was not used (control group). Note the thick, continuous deposit of secretions on the lumen of the endotracheal tube containing cells. (C) and (D): Electron micrograph of the inner surface of an ETT where Mucus Shaver was used. Few small drops (few to 20 µm) are noted on the ETT lumen.