Structural Features of Tracheal Tube Biofilm Formed During Prolonged Mechanical Ventilation

Inglis, Tim; Lim, Teck Guan; Mah-Lee, Ng; Ee-Koon, Tang; Kok-Pheng, Hui

doi:10.1378/chest.108.4.1049

Cited by 64 publications

(45 citation statements)

References 8 publications

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“…This was noted from as early as 36 h, but was most prominent between 60±84 h. Isolation of micro-organisms from within the ETT itself was noted from as early as 48 h (scanty isolation), while colonization in significant amounts was most apparent at 96 h. It is interesting to note that the appearance of microorganisms in lower respiratory tract secretions of these patients almost invariably preceded their appearance in the interior of the ETT. This suggests that colonization of the ETT in these patients occurred from the lower respiratory tract, as has been suggested by others [16,17]. This conclusion is strengthened by two additional observations in this study.…”

Section: Discussionsupporting

confidence: 91%

“…They suggested that there may be a relationship between nosocomial pulmonary infections and bacterial adherence to the interior surface of the ETT [14]. Several investigators have subsequently studied this process further [15±17] and have suggested not only that the formation of a biofilm may be an important mechanism of ETT obstruction, but also a potential source of pulmonary infection [16,17].…”

mentioning

confidence: 99%

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The presence and sequence of endotracheal tube colonization in patients undergoing mechanical ventilation

Feldman

Kassel²,

Cantrell³

et al. 1999

Eur Respir J

217

139

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Endotracheal tube colonization in patients undergoing mechanical ventilation was investigated.In the first part of this prospective study, the airway access tube was examined for the presence of secretions, airway obstruction and bacterial colonization, in cases undergoing extubation or tube change. In the second part of the study, the sequence of oropharyngeal, gastric, respiratory tract and endotracheal tube colonization was investigated by sequential swabbing at each site twice daily for 5 days in consecutive noninfected patients.In the first part, it was noted that all airway access tubes of cases undergoing extubation had secretions lining the interior of the distal third of the tube which were shown on scanning electron microscopy to be a biofilm. Gram-negative micro-organisms were isolated from these secretions in all but three cases. In the second part, it was noted that the sequence of colonization in patients undergoing mechanical ventilation was the oropharynx (36 h), the stomach (36±60 h), the lower respiratory tract (60±84 h), and thereafter the endotracheal tube (60±96 h). Nosocomial pneumonia occurred in 13 patients and in eight cases identical organisms were noted in lower respiratory tract secretions and in secretions lining the interior of the endotracheal tube.The endotracheal tube of patients undergoing mechanical ventilation becomes colonized rapidly with micro-organisms commonly associated with nosocomial pneumonia, and which may represent a persistent source of organisms causing such infections. Eur Respir J 1999; 13: 546±551.

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Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

The presence and sequence of endotracheal tube colonization in patients undergoing mechanical ventilation

Feldman

Kassel²,

Cantrell³

et al. 1999

Eur Respir J

217

139

View full text Add to dashboard Cite

show abstract

“…4,35 Bacteria were observed in 73% of the cases, mainly Pseudomonas species and Enterobacteriaceae. 32 Feldman et al 36 found the same microorganisms on the ETT biofilm as the microorganisms involved in VAP, in subjects treated for VAP. Adair et al 9 observed this correlation in 70% of cases.…”

Section: Discussionmentioning

confidence: 93%

“…During ventilation, the ETT is progressively covered by accumulation of respiratory secretions, comporting cell fragments, immune cells, and microorganisms, termed biofilm by several authors. 32 In our study, labile secretions were removed at least partially by the fixation solution, so we decided to first rinse out the ETT softly to remove this labile part of humid secretions. We studied only the deeper layer on the ETT, where bacteria can develop under tracheal secretions secondarily deposited.…”

Section: Discussionmentioning

confidence: 99%

Description and Microbiology of Endotracheal Tube Biofilm in Mechanically Ventilated Subjects

Danin¹,

Girou²,

Legrand³

et al. 2014

Respir Care

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BACKGROUND: A biofilm is found on the inner side of endotracheal tubes (ETT) in mechanically ventilated patients, but its features and role in pneumonia remain unclear. METHODS: This prospective, observational, monocentric study included critically ill ventilated subjects. Measurement of the ETT inner volume was first performed before extubation using the acoustic reflection method. After extubation, the biofilm was studied by means of optical and atomic force microscopy. Bacteriological analysis was then performed and compared with clinical documentation. RESULTS: Twenty-four subjects were included. Duration of intubation lasted from 2 to 79 d (mean ؎ SD: 11 ؎ 15 d). The mean percentage of ETT volume loss evaluated in situ (n ‫؍‬ 21) was 7.1% and was not linked with the duration of intubation. Analyses with atomic force microscopy (n ‫؍‬ 6) showed a full coverage of the inner part of the tube with biofilm, even after saline rinse. Its thickness ranged from 0.8 to 5 m. Bacteriological cultures of the biofilm (n ‫؍‬ 22) often showed the same bacteria as in tracheal secretions, especially for pathogenic organisms. Pseudomonas aeruginosa and Candida albicans were among the most frequent microorganisms. In subjects who had experienced a successfully treated episode of ventilator-associated pneumonia (n ‫؍‬ 5), the responsible bacteria were still present in the biofilm. CONCLUSIONS: ETT biofilm is always present in intubated patients whatever the duration of intubation and appears quickly after intubation. Even after soft rinse, a small but measurable part of biofilm remains always present, and seems strongly adherent to the ETT lumen. It contains potentially pathogenic bacteria for the lung.

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“…[16][17][18][19] Although it is critical that cleaning of the CSC is performed after suctioning, it is evident from these data that there must be a valve present between the patient's airway and the cleaning chamber to prevent interruption to ventilation and loss of lung volume during this procedure. For the purposes of this study, catheter-cleaning time was standardized to 5 s. In clinical practice, this period may be much longer depending on how thick and tenacious the patient's secretions are and how difficult they are to remove from the catheter.…”

Section: Discussionmentioning

confidence: 99%

Lung Volume Changes During Cleaning of Closed Endotracheal Suction Catheters: A Randomized Crossover Study Using Electrical Impedance Tomography

et al. 2013

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BACKGROUND: Airway suctioning in mechanically ventilated patients is required to maintain airway patency. Closed suction catheters (CSCs) minimize lung volume loss during suctioning but require cleaning post-suction. Despite their widespread use, there is no published evidence examining lung volumes during CSC cleaning. The study objectives were to quantify lung volume changes during CSC cleaning and to determine whether these changes were preventable using a CSC with a valve in situ between the airway and catheter cleaning chamber. METHODS: This prospective randomized crossover study was conducted in a metropolitan tertiary ICU. Ten patients mechanically ventilated via volume-controlled synchronized intermittent mandatory ventilation (SIMV-VC) and requiring manual hyperinflation (MHI) were included in this study. CSC cleaning was performed using 2 different brands of CSC (one with a valve [Ballard Trach Care 72, Kimberly-Clark, Roswell, Georgia] and one without [Portex Steri-Cath DL, Smiths Medical, Dublin, Ohio]). The maneuvers were performed during both SIMV-VC and MHI. Lung volume change was measured via impedance change using electrical impedance tomography. A mixed model was used to compare the estimated means. RESULTS: During cleaning of the valveless CSC, significant decreases in lung impedance occurred during MHI (؊2563 impedance units, 95% CI 2213-2913, P < .001), and significant increases in lung impedance occurred during SIMV (762 impedance units, 95% CI 452-1072, P < .001). In contrast, cleaning of the CSC with a valve in situ resulted in non-significant lung volume changes and maintenance of normal ventilation during MHI and SIMV-VC, respectively (188 impedance units, 95% CI ؊136 to 511, P ‫؍‬ .22; and 22 impedance units, 95% CI ؊342 to 299, P ‫؍‬ .89). CONCLUSIONS: When there is no valve between the airway and suction catheter, cleaning of the CSC results in significant derangements in lung volume. Therefore, the presence of such a valve should be considered essential in preserving lung volumes and uninterrupted ventilation in mechanically ventilated patients.

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Structural Features of Tracheal Tube Biofilm Formed During Prolonged Mechanical Ventilation

Cited by 64 publications

References 8 publications

The presence and sequence of endotracheal tube colonization in patients undergoing mechanical ventilation

The presence and sequence of endotracheal tube colonization in patients undergoing mechanical ventilation

Description and Microbiology of Endotracheal Tube Biofilm in Mechanically Ventilated Subjects

Lung Volume Changes During Cleaning of Closed Endotracheal Suction Catheters: A Randomized Crossover Study Using Electrical Impedance Tomography

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