Mechanical ventilation through an endotracheal tube (ETT) is an accepted, life-saving procedure for patients with acute respiratory failure (ARF), after the failure of conventional treatments (O2 + drugs). However, the positioning of an ETT is an invasive procedure, that can be associated with the development of important complications, stress and discomfort, which may worsen the clinical condition of critically ill patients; moreover this situation of stress and discomfort often makes the administration of sedative agents necessary, with further clinical and psychological drawbacks. In more detail, the presence of a translaryngeal ETT can directly produce injuries at the contact point between the airway mucosa and the cuff of the ETT causing ulceration, inflammation and/or edema, and submucosal hemorrhage, that are the pathological “prelude” for life-threatening complications such as airway stenosis [1, 2]. Moreover, the presence of an ETT profoundly affects all the normal defense mechanisms against upper airway infection, probably increasing the risk of severe complications like nosocomial pneumonia, sinusitis, and ear infections.
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