BACKGROUND: Biofilm on the surface of endotracheal tubes (ETTs) is associated with ventilator-associated pneumonia. The use of silver-coated ETTs has been suggested to reduce the occurrence of ventilator-associated pneumonia by preventing biofilm formation. However, mucus accumulation can reduce the antibacterial activity of silver-coated ETTs by isolating bacterial colonies from the silver surface. We hypothesized that, in mechanically ventilated subjects, periodic removal of secretions through the use of a cleaning device would enhance the antimicrobial properties of silver-coated ETTs and thus reduce bacterial colonization. METHODS: Subjects were randomized to either standard suctioning (blind tracheal suctioning, control group) or blind tracheal suctioning plus cleaning maneuver every 8 h (treatment group). Tracheal aspirates were collected immediately before extubation for microbiological culture. After extubation, ETTs were collected for both cultural and non-cultural microbiological analysis and biofilm isolation. RESULTS: 39 subjects expected to be ventilated for > 48 h were enrolled; 36 ETTs (18 control, 18 treatment) and 29 tracheal samples (15 control, 14 treatment) were collected. Among the ETTs positive for bacterial colonization (15 vs 9, P =.18), cleaning maneuvers did not reduce microbial load, shown as the decimal logarithm of colony-forming units (CFU) per mL (1.6 ± 1.2 vs 0.9 ± 1.2 logCFU/mL, P =.15). There was a trend toward decreased biofilm deposition (439.5 ± 29.0 vs 288.9 ± 157.7 mg, P =.09) in the treated ETTs. No significant differences were observed in the number of positive tracheal aspirates (13 vs 10, P =.39) or in the microbial load (4.8 ± 4.0 vs 4.2 ± 3.8 logCFU/mL, P =.70) of tracheal secretions. Finally, no differences in the microbial load of Gram-positive organisms, Gram-negative organisms, or yeasts were found between the ETTs and tracheal aspirates of the 2 groups. CONCLUSIONS: In 39 critically-ill subjects intubated with silver-coated ETTs, periodic cleaning maneuvers did not decrease bacterial colonization of the ETTs and did not lower respiratory tract colonization compared to the standard suctioning. (Clinicaltrials.gov reg-istration NCT02120001.)

Pirrone, M., Imber, D., Marrazzo, F., Pinciroli, R., Zhang, C., Bry, L., et al. (2019). Silver-coated endotracheal tubes cleaned with a mechanism for secretion removal. RESPIRATORY CARE, 64(1), 1-9 [10.4187/respcare.06222].

Silver-coated endotracheal tubes cleaned with a mechanism for secretion removal

Pinciroli, Riccardo;Berra, Lorenzo
2019

Abstract

BACKGROUND: Biofilm on the surface of endotracheal tubes (ETTs) is associated with ventilator-associated pneumonia. The use of silver-coated ETTs has been suggested to reduce the occurrence of ventilator-associated pneumonia by preventing biofilm formation. However, mucus accumulation can reduce the antibacterial activity of silver-coated ETTs by isolating bacterial colonies from the silver surface. We hypothesized that, in mechanically ventilated subjects, periodic removal of secretions through the use of a cleaning device would enhance the antimicrobial properties of silver-coated ETTs and thus reduce bacterial colonization. METHODS: Subjects were randomized to either standard suctioning (blind tracheal suctioning, control group) or blind tracheal suctioning plus cleaning maneuver every 8 h (treatment group). Tracheal aspirates were collected immediately before extubation for microbiological culture. After extubation, ETTs were collected for both cultural and non-cultural microbiological analysis and biofilm isolation. RESULTS: 39 subjects expected to be ventilated for > 48 h were enrolled; 36 ETTs (18 control, 18 treatment) and 29 tracheal samples (15 control, 14 treatment) were collected. Among the ETTs positive for bacterial colonization (15 vs 9, P =.18), cleaning maneuvers did not reduce microbial load, shown as the decimal logarithm of colony-forming units (CFU) per mL (1.6 ± 1.2 vs 0.9 ± 1.2 logCFU/mL, P =.15). There was a trend toward decreased biofilm deposition (439.5 ± 29.0 vs 288.9 ± 157.7 mg, P =.09) in the treated ETTs. No significant differences were observed in the number of positive tracheal aspirates (13 vs 10, P =.39) or in the microbial load (4.8 ± 4.0 vs 4.2 ± 3.8 logCFU/mL, P =.70) of tracheal secretions. Finally, no differences in the microbial load of Gram-positive organisms, Gram-negative organisms, or yeasts were found between the ETTs and tracheal aspirates of the 2 groups. CONCLUSIONS: In 39 critically-ill subjects intubated with silver-coated ETTs, periodic cleaning maneuvers did not decrease bacterial colonization of the ETTs and did not lower respiratory tract colonization compared to the standard suctioning. (Clinicaltrials.gov reg-istration NCT02120001.)
Articolo in rivista - Articolo scientifico
Airway management; Airway obstruction; Biofilms; Intubation; Pneumonia; Ventilation; Ventilator-associated pneumonia; Pulmonary and Respiratory Medicine; Critical Care and Intensive Care Medicine
English
2019
64
1
1
9
open
Pirrone, M., Imber, D., Marrazzo, F., Pinciroli, R., Zhang, C., Bry, L., et al. (2019). Silver-coated endotracheal tubes cleaned with a mechanism for secretion removal. RESPIRATORY CARE, 64(1), 1-9 [10.4187/respcare.06222].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/217897
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