scholarly journals Biofilm formation on three different endotracheal tubes: A prospective clinical trial

2020 ◽  
Author(s):  
Hulda Rosa Thorarinsdottir ◽  
Thomas Kander ◽  
Anna Holmberg ◽  
Sarunas Petronis ◽  
Bengt Klarin
Keyword(s):  
Noble Metal ◽  
Biofilm Formation ◽  
Noble Metals ◽  
Ventilator Associated Pneumonia ◽  
High Grade ◽  
Invasive Ventilation ◽  
Mechanically Ventilated ◽  
Endotracheal Tubes ◽  
Frequent Event ◽  
Significant Difference

Abstract Background: Biofilm formation on endotracheal tubes (ETTs) is an early and frequent event in mechanically ventilated patients. The biofilm is believed to act as a reservoir for infecting microorganisms and thereby contribute to development and relapses of ventilator-associated pneumonia (VAP). Once a biofilm has formed on an ETT surface, it is difficult to eradicate. This clinical study aimed to compare biofilm formation on three widely used ETTs with different surface properties and to explore factors potentially predictive of biofilm formation.Methods: We compared the grade of biofilm formation on ETTs made of uncoated polyvinyl chloride (PVC), silicone-coated PVC, and PVC coated with noble metals after > 24 hours of mechanical ventilation in critically ill patients. The comparison was based on scanning electron microscopy of ETT surfaces, biofilm grading, surveillance and biofilm cultures, and occurrence of VAP.Results: High-grade (score ≥ 7) biofilm formation on the ETTs was associated with development of VAP (OR 4.17 [95% CI 1.14–15.3], p = 0.031). Compared to uncoated PVC ETTs, the silicone-coated and noble-metal-coated PVC ETTs were independently associated with reduced high-grade biofilm formation (OR 0.18 [95% CI 0.06–0.59], p = 0.005, and OR 0.34 [95% CI 0.13–0.93], p = 0.036, respectively). No significant difference was observed between silicon-coated ETTs and noble-metal-coated ETTs (OR 0.54 [95% CI 0.17–1.65], p = 0.278). In 60% of the oropharyngeal cultures and 58% of the endotracheal cultures collected at intubation, the same microorganism was found in the ETT biofilm at extubation. In patients who developed VAP, the causative microbe remained in the biofilm in 56% of cases, despite appropriate antibiotic therapy. High-grade biofilm formation on ETTs was not predicted by either colonization with common VAP pathogens in surveillance cultures or duration of invasive ventilation.Conclusion: High-grade biofilm formation on ETTs was associated with development of VAP. Compared to the uncoated PVC ETTs, the silicone-coated and noble-metal-coated PVC ETTs were independently associated with reduced high-grade biofilm formation. Further research on methods to prevent, monitor, and manage biofilm occurrence is needed.Trial registration: ClinicalTrials.gov, NCT02284438. Retrospectively registered on 21 October 2014, URL: https://clinicaltrials.gov/ct2/show/NCT02284438.

scholarly journals Biofilm formation on three different endotracheal tubes: a prospective clinical trial

2020 ◽  
Author(s):  
Hulda Rosa Thorarinsdottir ◽  
Thomas Kander ◽  
Anna Holmberg ◽  
Sarunas Petronis ◽  
Bengt Klarin
Keyword(s):  
Noble Metal ◽  
Biofilm Formation ◽  
Noble Metals ◽  
Ventilator Associated Pneumonia ◽  
High Grade ◽  
Invasive Ventilation ◽  
Mechanically Ventilated ◽  
Endotracheal Tubes ◽  
Frequent Event ◽  
Significant Difference

Abstract Background: Biofilm formation on endotracheal tubes (ETTs) is an early and frequent event in mechanically ventilated patients. The biofilm is believed to act as a reservoir for infecting microorganisms and thereby contribute to development and relapses of ventilator-associated pneumonia (VAP). Once a biofilm has formed on an ETT surface, it is difficult to eradicate. This clinical study aimed to compare biofilm formation on three widely used ETTs with different surface properties and to explore factors potentially predictive of biofilm formation.Methods: We compared the grade of biofilm formation on ETTs made of uncoated polyvinyl chloride (PVC), silicone-coated PVC, and PVC coated with noble metals after > 24 hours of mechanical ventilation in critically ill patients. The comparison was based on scanning electron microscopy of ETT surfaces, biofilm grading, surveillance and biofilm cultures, and occurrence of VAP.Results: High-grade (score ≥ 7) biofilm formation on the ETTs was associated with development of VAP (OR 4.17 [95% CI 1.14–15.3], p = 0.031). Compared to uncoated PVC ETTs, the silicone-coated and noble-metal-coated PVC ETTs were independently associated with reduced high-grade biofilm formation (OR 0.18 [95% CI 0.06–0.59], p = 0.005, and OR 0.34 [95% CI 0.13–0.93], p = 0.036, respectively). No significant difference was observed between silicon-coated ETTs and noble-metal-coated ETTs (OR 0.54 [95% CI 0.17–1.65], p = 0.278). In 60% of the oropharyngeal cultures and 58% of the endotracheal cultures collected at intubation, the same microorganism was found in the ETT biofilm at extubation. In patients who developed VAP, the causative microbe remained in the biofilm in 56% of cases, despite appropriate antibiotic therapy. High-grade biofilm formation on ETTs was not predicted by either colonization with common VAP pathogens in surveillance cultures or duration of invasive ventilation.Conclusion: High-grade biofilm formation on ETTs was associated with development of VAP. Compared to the uncoated PVC ETTs, the silicone-coated and noble-metal-coated PVC ETTs were independently associated with reduced high-grade biofilm formation. Further research on methods to prevent, monitor, and manage biofilm occurrence is needed.Trial registration: ClinicalTrials.gov, NCT02284438. Retrospectively registered on 21 October 2014, URL: https://clinicaltrials.gov/ct2/show/NCT02284438.

scholarly journals Biofilm formation on three different endotracheal tubes: a prospective clinical trial

2020 ◽  
Author(s):  
Hulda Rosa Thorarinsdottir ◽  
Thomas Kander ◽  
Anna Holmberg ◽  
Sarunas Petronis ◽  
Bengt Klarin
Keyword(s):  
Noble Metal ◽  
Biofilm Formation ◽  
Noble Metals ◽  
High Grade ◽  
Mechanically Ventilated ◽  
Endotracheal Tubes ◽  
Surveillance Cultures ◽  
Biofilm Removal ◽  
Frequent Event ◽  
Significant Difference

Abstract Background: Biofilm formation on endotracheal tubes (ETTs) is an early and frequent event in mechanically ventilated patients. The biofilm is believed to act as a reservoir for infecting microorganisms and thereby, contribute to development and relapses of ventilator-associated pneumonia (VAP). Once a biofilm has formed on an ETT surface, it is difficult to eradicate. This clinical study aimed to compare biofilm formation on three widely used ETTs with different surface properties and to explore factors potentially predictive of biofilm formation.Methods: We compared the grade of biofilm formation on ETTs made of uncoated polyvinyl chloride (PVC), silicone-coated PVC, and PVC coated with noble metals after > 24 hours of mechanical ventilation in critically ill patients. The comparison was based on scanning electron microscopy of ETT surfaces, biofilm grading, surveillance and biofilm cultures, and occurrence of VAP.Results: High-grade (score ≥ 7) biofilm formation on the ETTs was associated with development of VAP (OR 4.17 [95% CI 1.14–15.3], p = 0.031). Compared to uncoated PVC ETTs, the silicone-coated and noble-metal-coated PVC ETTs were independently associated with reduced high-grade biofilm formation (OR 0.18 [95% CI 0.06–0.59], p = 0.005 and OR 0.34 [95% CI 0.13–0.93], p = 0.036, respectively). No significant difference was observed between silicon-coated ETTs and noble-metal-coated ETTs (OR 0.54 [95% CI 0.17–1.65] p = 0.278). The microbes found in the ETT biofilm were frequently found in surveillance cultures at intubation and often remained in the biofilm despite appropriate antibiotic therapy. High-grade biofilm formation on ETTs was not predicted by either colonization with common VAP pathogens in surveillance cultures or duration of invasive ventilation.Conclusion: High-grade biofilm formation on ETTs was associated with development of VAP. Compared to the uncoated PVC ETTs, the silicone-coated and noble-metal coated PVC ETTs were independently associated with reduced high-grade biofilm formation. Methods aimed at the continuous monitoring of biofilm formation are warranted. Routines for biofilm removal need further study.Trial registration: ClinicalTrials.gov, NCT02284438. Retrospectively registered on 21 October 2014, URL: https://clinicaltrials.gov/ct2/show/NCT02284438.

scholarly journals Biofilm formation on three different endotracheal tubes: A prospective clinical trial

2020 ◽  
Author(s):  
Hulda Rosa Thorarinsdottir ◽  
Thomas Kander ◽  
Anna Holmberg ◽  
Sarunas Petronis ◽  
Bengt Klarin
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Biofilm Formation ◽  
Noble Metals ◽  
High Grade ◽  
Mechanically Ventilated ◽  
Endotracheal Tubes ◽  
Surveillance Cultures ◽  
Frequent Event ◽  
Significant Difference

Abstract Background: Biofilm formation on endotracheal tubes (ETTs) is an early and frequent event in mechanically ventilated patients. The biofilm is anticipated to act as a reservoir for infecting microorganisms, contributing to the development and relapses of ventilator-associated pneumonia (VAP). Once a biofilm has formed on an ETT surface it is difficult to eradicate. The aims of this clinical study were to compare biofilm formation on three widely used ETT´s with different surface properties and to explore possible predictive factors of biofilm formation. Methods: The grade of biofilm formation on endotracheal tubes of polyvinyl chloride (PVC), silicone-coated PVC, and PVC coated by noble metals were compared after mechanical ventilation for > 24 hours in critically ill patients. The comparison was based on scanning electron microscopy (SEM) observations of ETT surfaces and biofilm grading, surveillance and biofilm cultures, and the occurrence of VAP. Results: A high-grade (score ≥ 7) biofilm formation on the ETTs was associated with the development of VAP (OR, 4.17; 95% CI 1.14 to 15.3; p = 0.031). Silicone-coated ETTs and PVC tubes coated with noble metals were independently associated with reduced high-grade biofilm formation compared to non-coated PVC ETTs (OR, 0.18; 95% CI 0.06 to 0.59; p = 0.005 and OR, 0.34; 95% CI 0.13 to 0.93; p = 0.036, respectively). No significant difference was detected between silicon-coated ETTs and noble metal-coated ETTs (OR, 0.54; 95% CI 0.17 to 1.65; p = 0.278). The microbes found in the ETT biofilm were frequently found in surveillance cultures at intubation and often remained in the biofilm after appropriate antibiotic therapy. Colonization with common VAP pathogens in surveillance cultures or duration of invasive ventilation did not predict higher biofilm formation on ETTs. Conclusion: Biofilm formation on ETTs were an early and frequent event in critically ill patients. High-grade biofilm formation on ETTs was associated with the development of VAP. Silicone-coated ETTs and PVC tubes coated with noble metals were independently associated with reduced high-grade biofilm formation in comparison to non-coated PVC ETTs. Clinicians may consider changing the ETT after an episode of VAP to avoid microbial persistence and possibly VAP relapse.

scholarly journals EARLY PROBIOTICS IN PREVENTING VENTILATOR-ASSOCIATED PNEUMONIA AFTER MULTIPLE TRAUMA

2020 ◽  
pp. 83-85
Author(s):  
TAMER HABIB ◽  
AMIRA B KASSEM ◽  
ISLAM AHMED
Keyword(s):  
Multiple Trauma ◽  
University Hospital ◽  
Control Group ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Mechanically Ventilated ◽  
Significant Difference ◽  
Multiple Trauma Patients ◽  
And Control

Objective: Using probiotics in preventing ventilator-associated pneumonia (VAP) remain controversial due to different intensive care unit (ICU) populations included in such studies. The aim of this study is to evaluate the role of probiotics in prophylaxis of VAP after multiple trauma. Methods: Sixty-five adult multiple trauma patients on mechanical ventilator (expected ≥48 h) after admission to the Critical Care Medicine Department, Alexandria Main University Hospital from June to November 2018. Patients were randomly assigned using computer sheet into two groups; probiotics group (32 patients received one Lacteol Forte® sachet through orogastric/nasogastric tube 3 times daily during their ICU stay) and control group (33 patients received similar regimen of placebo sachets). All patients were followed up and subjected to all possible strategies of the diagnosis of microbiologically confirmed VAP. Results: Sixty-five patients were enrolled with a mean of age (39.48±7.692) years, 80% of them were male. Regarding the incidence of VAP, it was 18.46% of all patients without statistically significant difference between probiotics group (15.63%) and control group (21.21%) (p=0.751). Conclusion: Routine use of early probiotics in mechanically ventilated multiple trauma patients was not associated with lower incidence of VAP, duration of MV, or ICU mortality.

Probiotics for Disease Prevention: A Focus on Ventilator-Associated Pneumonia

2011 ◽  
Vol 45 (11) ◽  
pp. 1425-1432 ◽  
Author(s):  
Jennifer L Bailey ◽  
Siu Yan Yeung
Keyword(s):  
Antimicrobial Agents ◽  
Future Research ◽  
Published Data ◽  
Ventilator Associated Pneumonia ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Patient Disposition ◽  
Significant Difference ◽  
Colonization Rates ◽  
Ventilated Patients

Objective: To summarize published data regarding the safety and efficacy of probiotics in the prevention of ventilator-associated pneumonia (VAP). Data Sources: PubMed databases (January 2000-August 2011) were searched and a bibliographic review of published articles was performed to identify original reports of probiotic administration for the prevention of VAP using the search terms probiotics, synbiotics, and ventilator-associated pneumonia. Study Selection and Data Extraction: Two pilot studies, 2 randomized controlled trials (RCTs), and 1 meta-analysis have addressed probiotic use for VAP prevention and were included in the review. Data Synthesis: VAP frequently occurs in mechanically ventilated patients. Given the lack of new antimicrobial agents, probiotics have been studied for their ability to modify human microflora colonization. Two studies examining pathogen colonization rates favored probiotics, with reduced incidence and increased duration until the emergence of new species. One prospective RCT found significant reduction in the incidence of VAP and colonization rates, but no significant difference in patient disposition outcomes. Another RCT examining 28-day mortality found no overall benefit with probiotic use and no reduction in colonization rates. Conclusions: Clinical trials have failed to demonstrate a consistent beneficial effect of probiotics in mechanically ventilated patients; thus, they are not recommended for routine clinical use. However, heterogeneity among study designs may hinder this assessment and the designs should be unified in future research.

scholarly journals The prevalence of suspected ventilator-associated pneumonia in Scottish intensive care units

2019 ◽  
Vol 21 (2) ◽  
pp. 140-147
Author(s):  
Robert Hart ◽  
Scott McNeill ◽  
Sarah Maclean ◽  
Jamie Hornsby ◽  
Sarah Ramsay
Keyword(s):  
Data Collection ◽  
Ventilator Associated Pneumonia ◽  
Healthcare Associated Infection ◽  
Screening Process ◽  
Mechanically Ventilated ◽  
Endotracheal Tubes ◽  
Data Comparison ◽  
Healthcare Associated ◽  
The Impact ◽  
Meaningful Data

Ventilator-associated pneumonia is the most common healthcare-associated infection in mechanically ventilated patients. Despite this, accurate diagnosis of ventilator-associated pneumonia is difficult owing to the variety of criteria that exist. In this prospective national audit, we aim to quantify the existence of patients with suspected ventilator-associated pneumonia that would not be detected by our standard healthcare-associated infection screening process. Furthermore, we aim to assess the impact of tracheostomy insertion, subglottic drainage endotracheal tubes and chlorhexidine gel on ventilator-associated pneumonia rate. Of the 227 patients recruited, suspected ventilator-associated pneumonia occurred in 32 of these patients. Using the HELICS definition, 13/32 (40.6%) patients were diagnosed with ventilator-associated pneumonia (H-posVAP). Suspected ventilator-associated pneumonia rate was increased in our tracheostomy population, decreased in the subglottic drainage endotracheal tube group and unchanged in the chlorhexidine group. The diagnosis of ventilator-associated pneumonia remains a contentious issue. The formalisation of the HELICS criteria by the European CDC should allow standardised data collection throughout Europe, which will enable more consistent data collection and meaningful data comparison in the future. Our data add weight to the argument against routine oral chlorhexidine. The use of subglottic drainage endotracheal tubes in preventing ventilator-associated pneumonia is interesting and requires further investigation.

Reduced Resistance to Air Flow from Nanomodified Endotracheal Tubes

2011 ◽  
Vol 1316 ◽  
Author(s):  
Mary C. Machado ◽  
Keiko M. Tarquinio ◽  
Thomas J. Webster
Keyword(s):  
Biofilm Formation ◽  
Cost Effective ◽  
Clinical Problem ◽  
Flow Chamber ◽  
High Morbidity ◽  
Ventilator Associated Pneumonia ◽  
Pressure Gradients ◽  
Dynamic Flow ◽  
Endotracheal Tubes ◽  
Significant Evidence

AbstractVentilator associated pneumonia (VAP) is a serious and costly clinical problem. Specifically, receiving mechanical ventilation over 24 hours increases the risk of VAP and is associated with high morbidity, mortality and medical costs. Cost effective endotracheal tubes (ETTs) that are resistant to bacterial infection would help to prevent this problem. The objective of this study was to determine differences in bacterial growth on nanomodified and unmodified ETTs under dynamic airway conditions, a bench top model based upon the general design of Hartmann et al. (1999) was constructed to test of the effectiveness of nanomodified ETTs under the airflow conditions present in the airway. Twenty-four hour studies performed in a dynamic flow chamber showed a marked difference in the biofilm formation on different areas of unmodified tubes. Areas where tubes were curved, such as at the entrance to the mouth and the connection between the oropharynx and the larynx, seemed to collect the largest amount of biofilm. On the nanomodified tubes biofilm formation was markedly different occurring on smaller pieces.The biofilm formation on ETTs in the airflow system after 24 hours showed a large difference depending upon where tubes were oriented within the apparatus. This illustrates the importance of dynamic flow on biofilm formation in pediatric ETTs. It is of particular interest that increased biofilm density on both unmodified and nanomodified tubes appeared to occur at curves in the tube where changes in flow pattern occured. This emphasizes the need for more accurate models of airflow within pediatric ETTs, suggesting that not only does flow affect pressure gradients along the tube, but in fact, determines the composition of the film itself. More testing is needed to determine the effects of biofilm formation on the efficiency of ETT under airflow, however this study provides significant evidence for nanomodification alone (without the use of antibiotics) to decrease bacteria function.

scholarly journals Chlorhexidine Oral Care in Critically Ill Adults

2021 ◽  
Vol 1 (10) ◽  
Author(s):  
Anusree Subramonian ◽  
Jennifer Horton
Keyword(s):  
Critical Care ◽  
Randomized Clinical Trials ◽  
Oral Care ◽  
Clinical Effectiveness ◽  
Ventilator Associated Pneumonia ◽  
Specific Recommendation ◽  
Mechanically Ventilated ◽  
Care Protocol ◽  
Significant Difference ◽  
Critically Ill Adults

Three systematic reviews and 2 randomized clinical trials were identified regarding the clinical effectiveness of chlorhexidine oral care in adult patients who were in critical care and being mechanically ventilated. The evidence was of limited quality, with methodological limitations. Compared to ozonated water and to Nanosil, chlorhexidine oral care was associated with a significantly higher risk of ventilator-associated pneumonia. Compared to bicarbonate, chlorhexidine oral care was associated with a significantly lower risk of ventilator-associated pneumonia. There was no significant difference in the risk of ventilator-associated pneumonia between chlorhexidine and other agents, such as potassium permanganate, hydrogen peroxide, or miswak. There was no significant difference in the risk of mortality between oral care with chlorhexidine and that with other oral care drugs. An evidence-based guideline targeting individuals who require assistance on oral care recommended a multi-component oral care protocol. No specific recommendation regarding the use of oral care agents for the prevention of ventilator-associated pneumonia was made because of lack of evidence. There is a lack of evidence on the safety or cost-effectiveness of chlorhexidine oral care in adults who are in critical care and being mechanically ventilated.

scholarly journals Efficacy of Hi-Lo Evac Endotracheal Tube in Prevention of Ventilator-Associated Pneumonia in Mechanically Ventilated Poisoned Patients

Scientifica ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Ahmad Ghoochani Khorasani ◽  
Shahin Shadnia ◽  
Mohammad Mashayekhian ◽  
Mitra Rahimi ◽  
Abbas Aghabiklooei
Keyword(s):  
Endotracheal Tube ◽  
Control Group ◽  
Case Group ◽  
Ventilator Associated Pneumonia ◽  
Mechanically Ventilated ◽  
Subglottic Secretion ◽  
Icu Length Of Stay ◽  
Significant Difference ◽  
Subglottic Secretion Drainage ◽  
Health Care Associated Infection

Background. Ventilator-associated pneumonia (VAP) is the most common health care-associated infection. To prevent this complication, aspiration of subglottic secretions using Hi-Lo Evac endotracheal tube (Evac ETT) is a recommended intervention. However, there are some reports on Evac ETT dysfunction. We aimed to compare the incidence of VAP (per ventilated patients) in severely ill poisoned patients who were intubated using Evac ETT versus conventional endotracheal tubes (C-ETT) in our toxicology ICU.Materials and Methods. In this clinical randomized trial, 91 eligible patients with an expected duration of mechanical ventilation of more than 48 hours were recruited and randomly assigned into two groups: (1) subglottic secretion drainage (SSD) group who were intubated by Evac ETT (n=43) and (2) control group who were intubated by C-ETT (n=48).Results. Of the 91 eligible patients, 56 (61.5%) were male. VAP was detected in 24 of 43 (55.8%) patients in the case group and 23 of 48 (47.9%) patients in the control group (P=0.45). The most frequently isolated microorganisms wereS. aureus(54.10%) andAcinetobacterspp. (19.68%). The incidence of VAP and ICU length of stay were not significantly different between the two groups, but duration of intubation was statistically different and was longer in the SSD group. Mortality rate was less in SSD group but without a significant difference (P=0.68).Conclusion. The SSD procedure was performed intermittently with one-hour intervals using 10 mL syringe. Subglottic secretion drainage does not significantly reduce the incidence of VAP in patients receiving MV. This strategy appears to be ineffective in preventing VAP among ICU patients.

scholarly journals Endotracheal Tube Biofilm and its Impact on the Pathogenesis of Ventilator-Associated Pneumonia

2018 ◽  
Vol 4 (2) ◽  
pp. 50-55 ◽  
Author(s):  
Olguța Diaconu ◽  
Ianis Siriopol ◽  
Laura Iulia Poloșanu ◽  
Ioana Grigoraș
Keyword(s):  
Endotracheal Tube ◽  
Biofilm Formation ◽  
Temporal Dynamics ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Ventilator Associated Pneumonia ◽  
Mechanically Ventilated ◽  
Source Of Infection ◽  
Structured Analysis

AbstractVentilator-associated pneumonia (VAP) is a common and serious nosocomial infection in mechanically ventilated patients and results in high mortality, prolonged intensive care unit- (ICU) and hospital-length of stay and increased costs. In order to reduce its incidence, it is imperative to better understand the involved mechanisms and to identify the source of infection. The role of the endotracheal tube (ET) in VAP pathogenesis became more prominent over the last decades, along with extensive research dedicated to medical device-related infections and biofilms. ET biofilm formation is an early and constant process in intubated patients. New data regarding its temporal dynamics, composition, germ identification and consequences enhance knowledge about VAP occurrence, microbiology, treatment response and recurrence. This paper presents a structured analysis of the medical literature to date, in order to outline the role of ET biofilm in VAP pathogenesis and to review recommended methods to identify ET biofilm microorganisms and to prevent or decrease VAP incidence.

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