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INTRODUCTION: Intubation compromises mucus clearance, allowing secretions to accumulate inside the endotracheal tube (ETT). The purpose of this trial was to evaluate a novel device for ETT cleaning. We hypothesized that its routine use would reduce tube occlusion due to mucus accumulation, while decreasing airway bacterial colonization. METHODS: Subjects were randomized to either the use of the device every 8 h, or the institutional standard of care (blind tracheal suction) only. ETTs were collected at extubation and analyzed with high-resolution computed tomography (HRCT) for quantification of mucus volume. Microbiological testing was performed on biofilm samples. Vital signs and ventilatory settings were collected at the bedside. In-hospital follow-up was conducted, and a final evaluation survey was completed by respiratory therapists. RESULTS: Seventy-four subjects expected to remain intubated for longer than 48 h were enrolled (77 ETTs, 37 treatment vs 40 controls). Treated tubes showed reduced mucus accumulation (0.56 ± 0.12 vs 0.71 ± 0.28 mL; P = .004) and reduced occlusion (6.3 ± 1.7 vs 8.9 ± 7.6%; P = .039). The HRCT slice showing the narrowest lumen within each ETT exhibited less occlusion in cleaned tubes (10.6 ± 8.0 vs 17.7 ± 13.4%, 95% CI: 2–12.1; P = .007). Data on microbial colonization showed a trend in the treatment group toward a reduced ETT-based biomass of bacteria known to cause ventilator-associated pneumonia. No adverse events were reported. The staff was satisfied by the overall safety and feasibility of the device. CONCLUSION: The endOclear is a safe and effective device. It prevents luminal occlusion, thereby better preserving ETT nominal function.

Learning Objectives: Intubation compromises mucus clearance and secretions accumulate inside the endotracheal tube (ETT). Purpose of this randomized con- trolled study is to clinically evaluate the efficacy of the Endoclear®, a novel device for ETT cleaning, to reduce tube occlusion due to mucus accumulation while decreasing airway bacterial colonization. Methods: e Endoclear is a sterile, single-use catheter with a wiping apparatus at its distal end. Once in position, the cleaning device is expanded, and then withdrawn from the tube, thereby removing endoluminal debris. Patients were randomized to either the use of the device every 8 hours or blind suctioning through a closed system (control group). ETTs were collected at extubation, and subsequently analyzed with High- Resolution Computed Tomography for quantification of endoluminal mucus volume. Bacterial and fungal cultures were obtained from samples of endolu- minal biofilm collected through bath sonication of the whole mucus content in each ETT. An evaluation survey was also submitted to the involved Respiratory erapists. Results: 74 patients expected to remain intubated for more than 48 hours were enrolled for a total of 76 ETTs (37 vs 39 controls) analyzed. Average luminal occlusion ratio was significantly lower in the treated ETTs (mucus/total tube volume %ml: 6.3 ± 1.7 vs 8.9 ± 7.6; p=0.04). e analysis of slice-by-slice cross-sectional area also yielded significant results, particularly comparing the point of maximum occlusion within each tube (mucus/total slice area %mm2: 17.7 ± 13.4% vs 10.6 ± 8.0, control vs treatment; p