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Crit Care. 2015 Feb 27;19:59. doi: 10.1186/s13054-015-0785-0.

Endotracheal tube biofilm translocation in the lateral Trendelenburg position.

Author information

1
Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. glibassi@clinic.ub.es.
2
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. glibassi@clinic.ub.es.
3
Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain. glibassi@clinic.ub.es.
4
Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. LFERNAN1@clinic.ub.es.
5
Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain. LFERNAN1@clinic.ub.es.
6
Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. linasaucedo@hotmail.com.
7
Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain. linasaucedo@hotmail.com.
8
University of Milan, Milan, Italy. valeria.giunta@gmail.com.
9
Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. jd.martibcn@gmail.com.
10
Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain. jd.martibcn@gmail.com.
11
Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. otavioranzani@yahoo.com.br.
12
Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain. otavioranzani@yahoo.com.br.
13
Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Pulmonary Intensive Care Unit, São Paulo, Brazil. otavioranzani@yahoo.com.br.
14
Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. eli_agui@hotmail.com.
15
Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain. eli_agui@hotmail.com.
16
Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. montserrat.rigol@idibaps.org.
17
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. montserrat.rigol@idibaps.org.
18
Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain. montserrat.rigol@idibaps.org.
19
Department of Clinical Microbiology, School of Medicine, and Barcelona Centre for International Health Research, (CRESIB) Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. IGROCA@clinic.ub.es.
20
Department of Clinical Microbiology, School of Medicine, and Barcelona Centre for International Health Research, (CRESIB) Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. eslaura_1812@hotmail.com.
21
Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. nesmedic@hotmail.com.
22
Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. marianoesperatti@gmail.com.
23
Pathology Department, Hospital Clinic, Barcelona, Spain. MASACO@clinic.ub.es.
24
Pathology Department, Hospital Clinic, Barcelona, Spain. JRAMIREZ@clinic.ub.es.
25
Department of Clinical Microbiology, School of Medicine, and Barcelona Centre for International Health Research, (CRESIB) Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. JVILA@clinic.ub.es.
26
University of Barcelona, Barcelona, Spain. JVILA@clinic.ub.es.
27
Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. MIFERRER@clinic.ub.es.
28
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. MIFERRER@clinic.ub.es.
29
Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain. MIFERRER@clinic.ub.es.
30
Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. atorres@clinic.ub.es.
31
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. atorres@clinic.ub.es.
32
Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain. atorres@clinic.ub.es.
33
University of Barcelona, Barcelona, Spain. atorres@clinic.ub.es.

Abstract

INTRODUCTION:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

PMID:
25887536
PMCID:
PMC4355496
DOI:
10.1186/s13054-015-0785-0
[Indexed for MEDLINE]
Free PMC Article

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