When patients are intubated, their endotracheal tubes may accumulate secretions, typically more concentrated towards the distal end of the tube (commonly noted at extubation). There are at least two reasons for this particular pattern of accumulation of secretions, which often keeps clinical suspicion low for their presence. The first reason is that as an airway suction catheter is withdrawn from the patient's natural airway and into the endotracheal tube, airway secretions coating the catheter are wiped off onto the inner lumen of the endotracheal tube, and more secretions are present as the suction catheter makes initial contact with the distal end of the endotracheal tube. The second reason is the patient's recumbent position, which keeps the distal end of the endotracheal tube in a dependent position and makes it nearly impossible for the patient to expectorate the secretions himself or herself. Because secretions are characteristically concentrated towards the distal end of the endotracheal tube, they tend to remain "out of sight and out of mind" until the patient is extubated or a tracheostomy is performed.
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Accumulated secretions and bacterial biofilms can be seen clinically with fiberoptic bronchoscopic examination of the endotracheal tube, typically performed for diagnosing ventilator-associated pneumonia or for suspected endotracheal tube occlusion by inspissated, tenacious secretions. Aggregates of bacteria-laden secretions can become dislodged from the lumen of the endotracheal tube by a ventilator breath, by passage of an airway suction catheter or bronchoscope, or by saline lavage of the endotracheal tube. These macroscopic or microscopic clumps of infective material can be propelled or washed down into the distal airways, where they may serve as a nidus for infection and onset of ventilator-associated pneumonia. Even dead bacteria may incite an inflammatory host response, known as a pneumonitis, which can resemble (and may be difficult to differentiate from) pneumonia clinically.
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A closer look at the accumulated secretions within the lumen of an endotracheal tube reveals a combination of host mucus and bacterial biofilm. The overwhelming majority of bacteria in our environment live in biofilms, which appear to provide protection from, and a degree of resistance to, antibiotics to which particular species would normally be susceptible. The sophisticated microenvironments that are established in these biofilms include nutrient channels and even cell to cell communication via a process known as 'quorum sensing'.
The CAM Rescue Cath™ removes secretions, mucus and biofilm that adhere to the inside of the endotracheal tube. Equipped with our novel MaxFLO2™ secretion-removal mechanism (seen in this picture within an ET tube), it addresses clinically relevant problems that other airway suction catheters do not address (or may even contribute to).
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