Compliant hydrogel cuff coating with real-time pressure monitoring and antibiofilm capabilities for ventilator-associated pneumonia prophylaxis

The endotracheal tube (ETT) plays a critical role in maintaining airway patency during mechanical ventilation, with its cuff ensuring a proper seal upon inflation. However, inappropriate cuff pressure can inflict tracheal injury or compromise sealing integrity, while the cuff surface inherently promotes bacterial colonization and biofilm formation, both of which critically contribute to the pathogenesis of ventilator-associated pneumonia. Here, we present a compliant hydrogel coating for ETT cuffs that combines real-time pressure monitoring with intrinsic antibacterial protection. This soft hydrogel coating integrates a flexible pressure-sensing patch, ensuring compliant intubation and wireless dynamic pressure monitoring throughout ETT ventilation. Concurrently, the hydrogel inherently inhibits biofilm formation, and its antibacterial efficacy is substantially augmented upon drug loading. In vitro experiments demonstrated that this coating achieves bactericidal rates exceeding 99% against planktonic bacteria and over 90% clearance of biofilms. Furthermore, the in vivo biocompatibility and biosafety of this coating were verified in a 21-day murine subcutaneous implantation model. A goat endotracheal intubation model further confirmed that this coating provides continuous and reliable monitoring for abnormal pressure events, effectively mitigating airway tissue injury associated with conventional intubation and significantly reducing invasive irritation.