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Lloyd F, Robertson J, Murison PJ. Retrospective computed tomography analysis of endotracheal tube constriction and mispositioning in cats and dogs. Vet Anaesth Analg 2023; 50:467-476. [PMID: 37735027 DOI: 10.1016/j.vaa.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/31/2023] [Accepted: 07/13/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To discover the prevalence of endotracheal tube (ETT) constriction and rostral and caudal mispositioning in anaesthetized cats and dogs, and to identify associated risk factors. STUDY DESIGN Retrospective analysis. ANIMALS A total of 146 cats and 670 dogs. METHODS Computed tomography images of the head/neck/thorax from orotracheally intubated cats and dogs were visually assessed for constriction or mispositioning of the ETT. If constriction was present, measurements of the cross-sectional area (CSA) of the ETT lumen at constricted and un-constricted locations were compared. Location and cause of constriction were noted and the expected increase in resistance to gas flow was calculated. Animal information was collected from clinical records. Normality of continuous variables was assessed via the Shapiro-Wilk test. Chi-square tests examined associations between variables. Kendall's tau-b test was performed between measured ETT size and degree of constriction. RESULTS The ETT extended rostrally beyond incisors in 52% of cases; the connector was within the oral cavity in 19% of cases. The ETT extended beyond the first rib in 25.5% of cases. The prevalence of ETT constriction was 22.7%. Median reduction in CSA was 7.68% (0.14-64.19%). Median increase in resistance assuming laminar and turbulent flow was 16.5% (0.3-680%) and 21% (0.3-1200%), respectively. The most common cause of constriction was the presence of a radiotherapy mouth gag. Significant associations existed between presence of constriction and rostral mispositioning, and caudal mispositioning and extreme brachycephaly. Increased severity of constriction was more likely in smaller ETT. CONCLUSIONS AND CLINICAL RELEVANCE Constriction and mispositioning of ETT occurred very commonly in this population. Checking the ETT within the oral cavity for constriction and mispositioning is recommended. Radiotherapy mouth gags increase the risk of ETT compression. Smaller ETT are at greater risk of severe constriction. Brachycephalic dogs are at particular risk of caudal mispositioning.
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Affiliation(s)
- Ffion Lloyd
- Small Animal Hospital, University of Glasgow, School of Biodiversity, One Health and Veterinary Medicine, Glasgow, UK.
| | - Josephine Robertson
- Small Animal Hospital, University of Glasgow, School of Biodiversity, One Health and Veterinary Medicine, Glasgow, UK
| | - Pamela J Murison
- Small Animal Hospital, University of Glasgow, School of Biodiversity, One Health and Veterinary Medicine, Glasgow, UK
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2
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Alves D, Grainha T, Pereira MO, Lopes SP. Antimicrobial materials for endotracheal tubes: A review on the last two decades of technological progress. Acta Biomater 2023; 158:32-55. [PMID: 36632877 DOI: 10.1016/j.actbio.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023]
Abstract
Ventilator-associated pneumonia (VAP) is an unresolved problem in nosocomial settings, remaining consistently associated with a lack of treatment, high mortality, and prolonged hospital stay. The endotracheal tube (ETT) is the major culprit for VAP development owing to its early surface microbial colonization and biofilm formation by multiple pathogens, both critical events for VAP pathogenesis and relapses. To combat this matter, gradual research on antimicrobial ETT surface coating/modification approaches has been made. This review provides an overview of the relevance and implications of the ETT bioburden for VAP pathogenesis and how technological research on antimicrobial materials for ETTs has evolved. Firstly, certain main VAP attributes (definition/categorization; outcomes; economic impact) were outlined, highlighting the issues in defining/diagnosing VAP that often difficult VAP early- and late-onset differentiation, and that generate misinterpretations in VAP surveillance and discrepant outcomes. The central role of the ETT microbial colonization and subsequent biofilm formation as fundamental contributors to VAP pathogenesis was then underscored, in parallel with the uncovering of the polymicrobial ecosystem of VAP-related infections. Secondly, the latest technological developments (reported since 2002) on materials able to endow the ETT surface with active antimicrobial and/or passive antifouling properties were annotated, being further subject to critical scrutiny concerning their potentialities and/or constraints in reducing ETT bioburden and the risk of VAP while retaining/improving the safety of use. Taking those gaps/challenges into consideration, we discussed potential avenues that may assist upcoming advances in the field to tackle VAP rampant rates and improve patient care. STATEMENT OF SIGNIFICANCE: The use of the endotracheal tube (ETT) in patients requiring mechanical ventilation is associated with the development of ventilator-associated pneumonia (VAP). Its rapid surface colonization and biofilm formation are critical events for VAP pathogenesis and relapses. This review provides a comprehensive overview on the relevance/implications of the ETT biofilm in VAP, and on how research on antimicrobial ETT surface coating/modification technology has evolved over the last two decades. Despite significant technological advances, the limited number of gathered reports (46), highlights difficulty in overcoming certain hurdles associated with VAP (e.g., persistent colonization/biofilm formation; mechanical ventilation duration; hospital length of stay; VAP occurrence), which makes this an evolving, complex, and challenging matter. Challenges and opportunities in the field are discussed.
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Affiliation(s)
- Diana Alves
- CEB - Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; LABBELS - Associate Laboratory, Braga/Guimarães, Portugal.
| | - Tânia Grainha
- CEB - Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; LABBELS - Associate Laboratory, Braga/Guimarães, Portugal.
| | - Maria Olívia Pereira
- CEB - Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; LABBELS - Associate Laboratory, Braga/Guimarães, Portugal.
| | - Susana Patrícia Lopes
- CEB - Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; LABBELS - Associate Laboratory, Braga/Guimarães, Portugal.
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Wang Y, Cai B, Ni D, Sun Y, Wang G, Jiang H. A novel antibacterial and antifouling nanocomposite coated endotracheal tube to prevent ventilator-associated pneumonia. J Nanobiotechnology 2022; 20:112. [PMID: 35248076 PMCID: PMC8897767 DOI: 10.1186/s12951-022-01323-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The endotracheal tube (ETT) is an essential medical device to secure the airway patency in patients undergoing mechanical ventilation or general anesthesia. However, long-term intubation eventually leads to complete occlusion, ETTs potentiate biofilm-related infections, such as ventilator-associated pneumonia. ETTs are mainly composed of medical polyvinyl chloride (PVC), which adheres to microorganisms to form biofilms. Thus, a simple and efficient method was developed to fabricate CS-AgNPs@PAAm-Gelatin nanocomposite coating to achieve dual antibacterial and antifouling effects.
Results
The PAAm-Gelatin (PAAm = polyacrylamide) molecular chain gel has an interpenetrating network with a good hydrophilicity and formed strong covalent bonds with PVC-ETTs, wherein silver nanoparticles were used as antibacterial agents. The CS-AgNPs@PAAm-Gelatin coating showed great resistance and antibacterial effects against Staphylococcus aureus and Pseudomonas aeruginosa. Its antifouling ability was tested using cell, protein, and platelet adhesion assays. Additionally, both properties were comprehensively evaluated using an artificial broncho-lung model in vitro and a porcine mechanical ventilation model in vivo. These remarkable results were further confirmed that the CS-AgNPs@PAAm-Gelatin coating exhibited an excellent antibacterial capacity, an excellent stain resistance, and a good biocompatibility.
Conclusions
The CS-AgNPs@PAAm-Gelatin nanocomposite coating effectively prevents the occlusion and biofilm-related infection of PVC-ETTs by enhancing the antibacterial and antifouling properties, and so has great potential for future clinical applications.
Graphical Abstract
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4
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Lellouche F, Lavoie-Bérard CA, Rousseau E, Bouchard PA, Lefebvre JC, Branson R, Brochard L. How to avoid an epidemic of endotracheal tube occlusion. THE LANCET RESPIRATORY MEDICINE 2021; 9:1215-1216. [PMID: 34739886 PMCID: PMC8563017 DOI: 10.1016/s2213-2600(21)00404-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/26/2021] [Accepted: 09/01/2021] [Indexed: 11/19/2022]
Affiliation(s)
- François Lellouche
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, QC G1V 4G5, Canada; Département d'anesthésiologie et de soins intensifs, Division de soins intensifs, Université Laval, Quebec City, QC G1V 4G5, Canada.
| | - Carole-Anne Lavoie-Bérard
- Département d'anesthésiologie et de soins intensifs, Division de soins intensifs, Université Laval, Quebec City, QC G1V 4G5, Canada
| | - Emilie Rousseau
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, QC G1V 4G5, Canada
| | - Pierre-Alexandre Bouchard
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, QC G1V 4G5, Canada
| | - Jean-Claude Lefebvre
- Département d'anesthésiologie et de soins intensifs, Division de soins intensifs, Université Laval, Quebec City, QC G1V 4G5, Canada
| | - Richard Branson
- Department of Surgery, Division of Trauma and Critical Care, University of Cincinnati, Cincinnati, OH, USA
| | - Laurent Brochard
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
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5
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van der Hoeven S, Ball L, Constantino F, van Meenen DM, Pelosi P, Beenen LF, Schultz MJ, Paulus F. Effect of routine vs on-demand nebulization of acetylcysteine with salbutamol on accumulation of airway secretions in endotracheal tubes: substudy of a randomized clinical trial. Intensive Care Med Exp 2020; 8:71. [PMID: 33336283 PMCID: PMC7746420 DOI: 10.1186/s40635-020-00351-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accumulated airway secretions in the endotracheal tube increase work of breathing and may favor airway colonization eventually leading to pneumonia. The aim of this preplanned substudy of the 'Preventive Nebulization of Mucolytic Agents and Bronchodilating Drugs in Intubated and Ventilated Intensive Care Unit Patients trial' (NEBULAE) was to compare the effect of routine vs on-demand nebulization of acetylcysteine with salbutamol on accumulation of secretions in endotracheal tubes in critically ill patients. RESULTS In this single-center substudy of a national multicenter trial, patients were randomized to a strategy of routine nebulizations of acetylcysteine with salbutamol every 6 h until end of invasive ventilation, or to a strategy with on-demand nebulizations of acetylcysteine or salbutamol applied on strict clinical indications only. The primary endpoint, the maximum reduction in cross-sectional area (CSA) of the endotracheal tube was assessed with high-resolution computed tomography. Endotracheal tubes were collected from 72 patients, 36 from patients randomized to the routine nebulization strategy and 36 of patients randomized to the on-demand nebulization strategy. The maximum cross-sectional area (CSA) of the endotracheal tube was median 12 [6 to 15]% in tubes obtained from patients in the routine nebulization group, not different from median 9 [6 to 14]% in tubes obtained from patients in the on-demand nebulization group (P = 0.33). CONCLUSION In adult critically ill patients under invasive ventilation, routine nebulization of mucolytics and bronchodilators did not affect accumulation of airway secretions in the endotracheal tube. Trial registration Clinicaltrials.gov Identifier: NCT02159196.
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Affiliation(s)
- Sophia van der Hoeven
- Department of Intensive Care, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Lorenzo Ball
- Department of Intensive Care, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.,Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS per l'Oncologia e le Neuroscienze, Genova, Italy, Genova, Italy
| | - Federico Constantino
- Department of Intensive Care, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.,Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS per l'Oncologia e le Neuroscienze, Genova, Italy, Genova, Italy
| | - David M van Meenen
- Department of Anesthesiology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.,Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS per l'Oncologia e le Neuroscienze, Genova, Italy, Genova, Italy
| | - Ludo F Beenen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Marcus J Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Frederique Paulus
- Department of Intensive Care, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands. .,ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
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Mann EE, Magin CM, Mettetal MR, May RM, Henry MM, DeLoid H, Prater J, Sullivan L, Thomas JG, Twite MD, Parker AE, Brennan AB, Reddy ST. Micropatterned Endotracheal Tubes Reduce Secretion-Related Lumen Occlusion. Ann Biomed Eng 2016; 44:3645-3654. [PMID: 27535564 DOI: 10.1007/s10439-016-1698-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 07/12/2016] [Indexed: 01/01/2023]
Abstract
Tracheal intubation disrupts physiological homeostasis of secretion production and clearance, resulting in secretion accumulation within endotracheal tubes (ETTs). Novel in vitro and in vivo models were developed to specifically recapitulate the clinical manifestations of ETT occlusion. The novel Sharklet™ micropatterned ETT was evaluated, using these models, for the ability to reduce the accumulation of both bacterial biofilm and airway mucus compared to a standard care ETT. Novel ETTs with micropattern on the inner and outer surfaces were placed adjacent to standard care ETTs in in vitro biofilm and airway patency (AP) models. The primary outcome for the biofilm model was to compare commercially-available ETTs (standard care and silver-coated) to micropatterned for quantity of biofilm accumulation. The AP model's primary outcome was to evaluate accumulation of artificial airway mucus. A 24-h ovine mechanical ventilation model evaluated the primary outcome of relative quantity of airway secretion accumulation in the ETTs tested. The secondary outcome was measuring the effect of secretion accumulation in the ETTs on airway resistance. Micropatterned ETTs significantly reduced biofilm by 71% (p = 0.016) compared to smooth ETTs. Moreover, micropatterned ETTs reduced lumen occlusion, in the AP model, as measured by cross-sectional area, in distal (85%, p = 0.005), middle (84%, p = 0.001) and proximal (81%, p = 0.002) sections compared to standard care ETTs. Micropatterned ETTs reduced the volume of secretion accumulation in a sheep model of occlusion by 61% (p < 0.001) after 24 h of mechanical ventilation. Importantly, micropatterned ETTs reduced the rise in ventilation peak inspiratory pressures over time by as much as 49% (p = 0.005) compared to standard care ETTs. Micropatterned ETTs, demonstrated here to reduce bacterial contamination and mucus occlusion, will have the capacity to limit complications occurring during mechanical ventilation and ultimately improve patient care.
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Affiliation(s)
- Ethan E Mann
- Sharklet Technologies, Inc., 12635 E Montview Blvd., Suite 155, Aurora, CO, 80045, USA
| | - Chelsea M Magin
- Sharklet Technologies, Inc., 12635 E Montview Blvd., Suite 155, Aurora, CO, 80045, USA
| | - M Ryan Mettetal
- Sharklet Technologies, Inc., 12635 E Montview Blvd., Suite 155, Aurora, CO, 80045, USA
| | - Rhea M May
- Sharklet Technologies, Inc., 12635 E Montview Blvd., Suite 155, Aurora, CO, 80045, USA
| | - MiKayla M Henry
- Sharklet Technologies, Inc., 12635 E Montview Blvd., Suite 155, Aurora, CO, 80045, USA
| | - Heather DeLoid
- Preclinical Translational Services, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Justin Prater
- Preclinical Translational Services, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Lauren Sullivan
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - John G Thomas
- Department of Microbiology and Laboratory Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Mark D Twite
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Albert E Parker
- Department of Mathematical Sciences, Center for Biofilm Engineering, Montana State University, Bozeman, MT, USA
| | - Anthony B Brennan
- Department of Materials Science & Engineering, University of Florida, Gainesville, FL, USA.,J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Shravanthi T Reddy
- Sharklet Technologies, Inc., 12635 E Montview Blvd., Suite 155, Aurora, CO, 80045, USA.
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Aguilera Xiol E, Li Bassi G, Wyncoll D, Ntoumenopoulos G, Fernandez-Barat L, Marti JD, Comaru T, De Rosa F, Rigol M, Rinaudo M, Ferrer M, Torres A. Tracheal tube biofilm removal through a novel closed-suctioning system: an experimental study. Br J Anaesth 2016; 115:775-83. [PMID: 26475806 DOI: 10.1093/bja/aev340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Tracheal tube biofilm develops during mechanical ventilation. We compared a novel closed-suctioning system vs standard closed-suctioning system in the prevention of tracheal tube biofilm. METHODS Eighteen pigs, on mechanical ventilation for 76 h, with P. aeruginosa pneumonia were randomized to be tracheally suctioned via the KIMVENT* closed-suctioning system (control group) or a novel closed-suctioning system (treatment group), designed to remove tracheal tube biofilm through saline jets and an inflatable balloon. Upon autopsy, two tracheal tube hemi-sections were dissected for confocal and scanning electron microscopy. Biofilm area, maximal and minimal thickness were computed. Biofilm stage was assessed. RESULTS Sixteen animals were included in the final analysis. In the treatment and control group, the mean (sd) pulmonary burden was 3.34 (1.28) and 4.17 (1.09) log cfu gr(-1), respectively (P=0.18). Tracheal tube P. aeruginosa colonization was 5.6 (4.9-6.3) and 6.2 (5.6-6.9) cfu ml(-1) (median and interquartile range) in the treatment and control group, respectively (P=0.23). In the treatment group, median biofilm area was 3.65 (3.22-4.21) log10 μm2 compared with 4.49 (4.27-4.52) log10 μm2 in the control group (P=0.031). In the treatment and control groups, the maximal biofilm thickness was 48.3 (26.7-71.2) µm (median and interquartile range) and 88.8 (43.8-125.7) µm, respectively. The minimal thickness in the treatment and control group was 0.6 (0-4.0) µm and 23.7 (5.3-27.8) µm (P=0.040) (P=0.017). Earlier stages of biofilm development were found in the treatment group (P<0.001). CONCLUSIONS The novel CSS reduces biofilm accumulation within the tracheal tube. A clinical trial is required to confirm these findings and the impact on major outcomes.
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Affiliation(s)
- E Aguilera Xiol
- Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain
| | - G Li Bassi
- Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain University of Barcelona, Barcelona, Spain
| | - D Wyncoll
- Critical Care Unit, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - G Ntoumenopoulos
- Critical Care Unit, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom Physiotherapy Department, Guy's & St Thomas' NHS Foundation Trust, United Kingdom School of Physiotherapy, Australian Catholic University, North Sydney Campus, North Sydney, Australia
| | - L Fernandez-Barat
- Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain
| | - J D Marti
- Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain
| | - T Comaru
- Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain
| | - F De Rosa
- Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain University of Milan, Milan, Italy
| | - M Rigol
- Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain Department of Cardiology, Hospital Clinic, Barcelona, Spain
| | - M Rinaudo
- Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain
| | - M Ferrer
- Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain University of Barcelona, Barcelona, Spain
| | - A Torres
- Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain University of Barcelona, Barcelona, Spain
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8
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Coppadoro A, Bellani G, Bronco A, Lucchini A, Bramati S, Zambelli V, Marcolin R, Pesenti A. The use of a novel cleaning closed suction system reduces the volume of secretions within the endotracheal tube as assessed by micro-computed tomography: a randomized clinical trial. Ann Intensive Care 2015; 5:57. [PMID: 26714807 PMCID: PMC4695481 DOI: 10.1186/s13613-015-0101-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 12/13/2015] [Indexed: 11/16/2022] Open
Abstract
Background Early after intubation, a layer of biofilm covers the inner lumen of the endotracheal tube (ETT). Cleaning the ETT might prevent airways colonization by pathogens, reduce resistance to airflow, and decrease sudden ETT obstruction. We investigated the effectiveness of a cleaning closed suction system in maintaining the endotracheal tube free from secretions. Methods We conducted a single center, randomized controlled trial, in the general intensive care unit of a tertiary-level university hospital. We enrolled 40 adult critically ill patients expected to remain intubated for more than 48 h, within 24 h from intubation. Patients were randomized to receive three ETT cleaning maneuvers/day using a novel device (Airway Medix Closed Suction System™, cleaning group) or to standard care (no ETT cleaning, standard closed suction, control group). After extubation, the amount of secretions in the ETTs was measured by micro-computed tomography. Results The volume of secretions in the ETTs from the cleaning group was lower than controls (0.081 [0.021–0.306] vs. 0.568 [0.162–0.756] mL, p = 0.001), corresponding to a cross-sectional area reduction six times lower (1[0–3] vs. 6 [2–10] %, p = 0.001). In a subset of 16 patients, the resistance to airflow tended to be lower after 1 day of treatment (p = 0.063) and was lower after 2 days (0.024), while no difference was present at enrollment (p = 0.922). ETT colonization did not differ between the two groups. Conclusions The use of a novel cleaning closed suction system proved to be effective in reducing secretions present in the ETT after extubation, possibly reducing resistance to airflow during intubation. Trial registration: clinicaltrials.gov NCT01912105 Electronic supplementary material The online version of this article (doi:10.1186/s13613-015-0101-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Coppadoro
- Department of Health Science, University of Milan-Bicocca, Via Cadore 48, Monza (MB), 20900, Italy. .,A.Manzoni Hospital, Lecco, Italy.
| | - Giacomo Bellani
- Department of Health Science, University of Milan-Bicocca, Via Cadore 48, Monza (MB), 20900, Italy. .,Department of Anesthesia and Intensive Care, San Gerardo Hospital, Monza, Italy.
| | - Alfio Bronco
- Department of Health Science, University of Milan-Bicocca, Via Cadore 48, Monza (MB), 20900, Italy.
| | - Alberto Lucchini
- Department of Anesthesia and Intensive Care, San Gerardo Hospital, Monza, Italy.
| | - Simone Bramati
- Laboratory of Microbiology, San Gerardo Hospital, Monza, Italy.
| | - Vanessa Zambelli
- Department of Health Science, University of Milan-Bicocca, Via Cadore 48, Monza (MB), 20900, Italy.
| | - Roberto Marcolin
- Department of Anesthesia and Intensive Care, San Gerardo Hospital, Monza, Italy.
| | - Antonio Pesenti
- Department of Health Science, University of Milan-Bicocca, Via Cadore 48, Monza (MB), 20900, Italy. .,Department of Anesthesia and Intensive Care, San Gerardo Hospital, Monza, Italy.
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9
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Tracheal Tube Obstruction Assessed by Computed Tomography. Anesthesiology 2015; 123:236-7. [DOI: 10.1097/aln.0000000000000677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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