Real time monitoring of bacterial attachment to medical devices provides opportunities to detect early biofilm formation and instigate appropriate interventions before infection develops. This study utilises long period grating (LPG) optical fibre sensors, incorporated into the lumen of endotracheal tubes (ETTs), to monitor in real time, Pseudomonas aeruginosa surface colonisation and biofilm formation. The wavelength shift of LPG attenuation bands was monitored for 24 h and compared with biofilm biomass, quantified using confocal fluorescence microscopy imaging. Biofilm formation was compared on uncoated ETTs and optical fibres, and on a biofilm resistant acrylate polymer, after challenge in an artificial sputum or minimal growth medium (RPMI-1640). The LPG sensor was able to detect a biofilm biomass as low as 81 μg cm-2, by comparison with the confocal image quantification. An empirical exponential function was found to link the optical attenuation wavelength shift with the inverse of the biofilm biomass, allowing quantification of biofouling from the spectral response. Quantification from the sensor allows infection interception and early device removal, to reduce, for example, the risk of ventilator associated pneumonia.