The clinical and cost effectiveness of advanced airways protection device versus conventional endotracheal tubes in Intensive care unit patients requiring mechanical ventilation: a multicentre, pragmatic randomised clinical trial

A breathing tube is the pathway through which air flows into the lungs. Intensive care units (ICU) are specialist hospital wards that provide treatment and monitoring for people who are very ill. Close to 184,000 patients annually are admitted to NHS ICUs and 33% require help with their breathing, using a machine which is called invasive mechanical ventilation. Treatment involves placing a plastic tube through the mouth into the windpipe and attaching the person to a breathing machine (ventilator). A serious complication of this life-saving treatment is a chest infection or ventilator-associated pneumonia (VAP) which affects 20% of people on ventilators. It occurs when mucus, a jelly-like liquid that lines your lungs, throat, mouth, nose, that is infected drips down the back of the throat past the plastic tube into the lungs. Whilst VAP can be treated with antibiotics, some people will die and others will spend much longer on a ventilator. The alternative airway system aims to improve the windpipe seal and reduce the risk of infected mucus passing down into the lung, by maintaining the inflation of the protective cuff. Patient studies suggest this system is safe and effective at removing mucus and preventing lung infection. Some hospitals are using the alternative airway system. However, we do not know if the positive findings seen in a few hospitals would also be seen in the wider NHS, and whether the new tube is good value for money, resulting in benefits to patients. The National Institute for Health and Care Excellence (NICE), the organisation that provides guidance for health and care practitioners to deliver the best care, has therefore recommended a large-scale research study to see if this equipment is needed.