Systems, devices, and methods are disclosed for the cleaning of an endotracheal tube while a patient is being supported by a ventilator connected to the endotracheal tube. According to some embodiments, a mechanically-actuated non-inflatable cleaning device for scraping debris (e.g., biofilm) from an interior wall of an endotracheal tube is provided. In one embodiment, the cleaning device comprises an elongated member having a proximal end and a distal end and a mechanically-expandable scaffold positioned along the distal end of the elongated member. In one embodiment, the mechanically-expandable scaffold comprises one or more removal members configured to engage an interior surface of an endotracheal tube when the scaffold is in a radially-expanded position and to remove debris from the interior surface of the endotracheal tube when the device is withdrawn from the endotracheal tube.