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ETCare: a randomized, controlled, masked trial comparing two solutions for upper airway care in the NICU

Journal of Perinatology volume 27, pages 479–484 (2007)Cite this article

Abstract

Background:

Small quantities of normal saline are sometimes instilled into the endotracheal tube of intubated neonates, to assist with the removal of thick secretions and maintain patency of the endotracheal tube. However, saline is detrimental to the innate immune system of the upper airway mucosa, rapidly unfolding and inactivating antimicrobial peptides such as LL-37. We previously reported the preparation and feasibility testing of ‘ETCare’, a low-sodium, physiologically based solution for airway care, and we now report results of a randomized, masked, controlled, two-centered study testing ETCare vs sterile saline among 60 intubated NICU patients.

Study design:

Sixty intubated NICU patients were randomized to having their airway care with ETCare vs saline. Three hypotheses were tested: (1) tolerance – patients will tolerate ETCare for airway care as well as they tolerate saline, (2) nosocomial infections – ETCare will result in fewer tracheal aspirates where organisms grow and fewer cases of nosocomial sepsis, and (3) chronic lung disuse – ETCare will result in fewer patients discharged home on supplemental O2.

Results:

Thirty NICU patients with an endotracheal tube in place were randomized to receive their airway care with ETCare, and 30 to receive their care with saline. Only the pharmacist was aware of the randomization; the two solutions were visually indistinguishable and were dispensed in identical syringes. Tolerance of the solutions was similar. The ETCare recipients had trends toward fewer positive blood cultures (odds ratios (OR), 0.48; 95% confidence interval (CI), 0.13 to 1.68), and fewer discharges home on supplemental O2 (OR, 0.43; 95% CI, 0.14 to 1.32; P=0.075).

Conclusions:

On the basis of this study and our previous 10-patient feasibility trial, we maintain that, for airway care, intubated NICU patients tolerate ETCare as well as saline. Data from this study can be used in estimating the sample sizes needed for a phase III trial. We speculate that such a trial will demonstrate that, compared with saline, ETCare will result in fewer nosocomial infections and less chronic lung disease.

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Acknowledgements

This study was supported in part by a grant from the Deseret Foundation, Salt Lake City, Utah.

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Authors and Affiliations

  1. Neonatal Intensive Care, McKay-Dee Hospital Center, Intermountain Healthcare, Ogden, UT, USA

    R D Christensen, N Schmutz, D K Lambert & D D Woodhead

  2. Respiratory Therapy Department, LDS Hospital, Intermountain Healthcare, Salt Lake City, UT, USA

    G Rigby

  3. Neonatal Intensive Care, LDS Hospital, Intermountain Healthcare, Salt Lake City, UT, USA

    S E Wiedmeier & J Burnett

  4. Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA

    S E Wiedmeier

  5. Pharmacy Department, McKay-Dee Hospital Center, Intermountain Healthcare, Salt Lake City, UT, USA

    S H Scoffield

  6. Pharmacy Department, LDS Hospital, Intermountain Healthcare, Salt Lake City, UT, USA

    R Muelleck & K Snow

  7. Biostatistics and Data Center, LDS Hospital, Intermountain Healthcare, Salt Lake City, UT, USA

    G L Snow

Authors
  1. R D Christensen
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  2. G Rigby
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  4. D K Lambert
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  7. S H Scoffield
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  8. R Muelleck
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  9. K Snow
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  10. D D Woodhead
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  11. G L Snow
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Corresponding author

Correspondence to R D Christensen.

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Supplementary Information accompanies the paper on the Journal of Perinatology website (http://www.nature.com/jp)

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Christensen, R., Rigby, G., Schmutz, N. et al. ETCare: a randomized, controlled, masked trial comparing two solutions for upper airway care in the NICU. J Perinatol 27, 479–484 (2007). https://doi.org/10.1038/sj.jp.7211779

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