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Endotracheal tube biofilm translocation in the lateral Trendelenburg position.

ABSTRACT: Laboratory studies demonstrated that the lateral Trendelenburg position (LTP) is superior to the semirecumbent position (SRP) in the prevention of ventilator-associated pulmonary infections. We assessed whether the LTP could also prevent pulmonary colonization and infections caused by an endotracheal tube (ETT) biofilm.Eighteen pigs were intubated with ETTs colonized by Pseudomonas aeruginosa biofilm. Pigs were positioned in LTP and randomized to be on mechanical ventilatin (MV) up to 24 hour, 48 hour, 48 hour with acute lung injury (ALI) by oleic acid and 72 hour. Bacteriologic and microscopy studies confirmed presence of biofilm within the ETT. Upon autopsy, samples from the proximal and distal airways were excised for P.aeruginosa quantification. Ventilator-associated tracheobronchitis (VAT) was confirmed by bronchial tissue culture ?3 log colony forming units per gram (cfu/g). In pulmonary lobes with gross findings of pneumonia, ventilator-associated pneumonia (VAP) was confirmed by lung tissue culture ?3 log cfu/g.P.aeruginosa colonized the internal lumen of 16 out of 18 ETTs (88.89%), and a mature biofilm was consistently present. P.aeruginosa colonization did not differ among groups, and was found in 23.6% of samples from the proximal airways, and in 7.1% from the distal bronchi (P?=?0.001). Animals of the 24 hour group never developed respiratory infections, whereas 20%, 60% and 25% of the animals in group 48 hour, 48 hour-ALI and 72 hour developed P.aeruginosa VAT, respectively (P?=?0.327). Nevertheless, VAP never developed.Our findings imply that during the course of invasive MV up to 72 hour, an ETT P.aeruginosa biofilm hastily colonizes the respiratory tract. Yet, the LTP compartmentalizes colonization and infection within the proximal airways and VAP never develops.

SUBMITTER: Li Bassi G

PROVIDER: S-EPMC4355496 | biostudies-literature | 2015 Feb

REPOSITORIES: biostudies-literature

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Endotracheal tube biofilm translocation in the lateral Trendelenburg position.

Li Bassi Gianluigi G Fernandez-Barat Laia L Saucedo Lina L Giunta Valeria V Marti Joan Daniel JD Tavares Ranzani Otavio O Aguilera Xiol Eli E Rigol Montserrat M Roca Ignasi I Muñoz Laura L Luque Nestor N Esperatti Mariano M Saco Maria Adela MA Ramirez Jose J Vila Jordi J Ferrer Miguel M Torres Antoni A

Critical care (London, England) 20150227

<h4>Introduction</h4>Laboratory studies demonstrated that the lateral Trendelenburg position (LTP) is superior to the semirecumbent position (SRP) in the prevention of ventilator-associated pulmonary infections. We assessed whether the LTP could also prevent pulmonary colonization and infections caused by an endotracheal tube (ETT) biofilm.<h4>Methods</h4>Eighteen pigs were intubated with ETTs colonized by Pseudomonas aeruginosa biofilm. Pigs were positioned in LTP and randomized to be on mechan ...[more]

PMID: 25887536

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Project description:Background Endotracheal intubation in neonates is challenging and requires a high level of precision, due to narrow and short airways, especially in preterm newborns. The current gold standard for endotracheal tube (ETT) verification is chest X-ray (CXR); however, this method presents some limitations, such as ionizing radiation exposure and delayed in obtaining the radiographic images, that point of care ultrasound (POCUS) could overcome. Primary Objective To evaluate ultrasound efficacy in determining ETT placement adequacy in preterm and term newborns. Secondary Objective To compare the time required for ultrasound confirmation vs. time needed for other standard of care methods. Search Methods A search in Medline, PubMed, Google Scholar and in the Cochrane Central Register of Controlled Trials (CENTRAL) was performed. Our most recent search was conducted in September 2021 including the following keywords: “newborn”, “infant”, “neonate”, “endotracheal intubation”, “endotracheal tube”, “ultrasonography”, “ultrasound”. Selection Criteria We considered randomized and non-randomized controlled trials, prospective, retrospective and cross-sectional studies published after 2012, involving neonatal intensive care unit (NICU) patients needing intubation/intubated infants and evaluating POCUS efficacy and/or accuracy in detecting ETT position vs. a defined gold-standard method. Three review authors independently assessed the studies' quality and extracted data. Main Results We identified 14 eligible studies including a total of 602 ETT evaluations in NICU or in the delivery room. In about 80% of cases the gold standard for ETT position verification was CXR. Ultrasound was able to identify the presence of ETT in 96.8% of the evaluations, with a pooled POCUS sensitivity of 93.44% (95% CI: 90.4–95.75%) in detecting an appropriately positioned ETT as assessed by CXR. Bedside ultrasound confirmation was also found to be significantly faster compared to obtaining a CXR. Conclusion POCUS appears to be a fast and effective technique to identify correct endotracheal intubation in newborns. This review could add value and importance to the use of this promising technique.

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Endotracheal tube biofilm translocation in the lateral Trendelenburg position.

Publications

Endotracheal tube biofilm translocation in the lateral Trendelenburg position.

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