Endotracheal tube biofilm translocation in the lateral Trendelenburg position

Gianluigi Li Bassi, Laia Fernandez-Barat, Lina Saucedo, Valeria Giunta, Joan Daniel Marti, Otavio Tavares Ranzani, Eli Aguilera Xiol, Montserrat Rigol, Ignasi Roca, Laura Muñoz, Nestor Luque, Mariano Esperatti, Maria Adela Saco, Jose Ramirez, Jordi Vila, Miguel Ferrer, Antoni Torres

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Article number59
JournalCritical Care
Volume19
Issue number1
DOIs
Publication statusPublished - Feb 27 2015

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Head-Down Tilt
Biofilms
Ventilator-Associated Pneumonia
Mechanical Ventilators
Acute Lung Injury
Lung
Swine
Stem Cells
Infection
Bronchi
Oleic Acid
Respiratory Tract Infections
Respiratory System
Pseudomonas aeruginosa
Microscopy
Autopsy
Pneumonia

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Li Bassi, G., Fernandez-Barat, L., Saucedo, L., Giunta, V., Marti, J. D., Tavares Ranzani, O., ... Torres, A. (2015). Endotracheal tube biofilm translocation in the lateral Trendelenburg position. Critical Care, 19(1), [59]. https://doi.org/10.1186/s13054-015-0785-0

Endotracheal tube biofilm translocation in the lateral Trendelenburg position. / Li Bassi, Gianluigi; Fernandez-Barat, Laia; Saucedo, Lina; Giunta, Valeria; Marti, Joan Daniel; Tavares Ranzani, Otavio; Aguilera Xiol, Eli; Rigol, Montserrat; Roca, Ignasi; Muñoz, Laura; Luque, Nestor; Esperatti, Mariano; Saco, Maria Adela; Ramirez, Jose; Vila, Jordi; Ferrer, Miguel; Torres, Antoni.

In: Critical Care, Vol. 19, No. 1, 59, 27.02.2015.

Research output: Contribution to journalArticle

Li Bassi, G, Fernandez-Barat, L, Saucedo, L, Giunta, V, Marti, JD, Tavares Ranzani, O, Aguilera Xiol, E, Rigol, M, Roca, I, Muñoz, L, Luque, N, Esperatti, M, Saco, MA, Ramirez, J, Vila, J, Ferrer, M & Torres, A 2015, 'Endotracheal tube biofilm translocation in the lateral Trendelenburg position', Critical Care, vol. 19, no. 1, 59. https://doi.org/10.1186/s13054-015-0785-0
Li Bassi G, Fernandez-Barat L, Saucedo L, Giunta V, Marti JD, Tavares Ranzani O et al. Endotracheal tube biofilm translocation in the lateral Trendelenburg position. Critical Care. 2015 Feb 27;19(1). 59. https://doi.org/10.1186/s13054-015-0785-0
Li Bassi, Gianluigi ; Fernandez-Barat, Laia ; Saucedo, Lina ; Giunta, Valeria ; Marti, Joan Daniel ; Tavares Ranzani, Otavio ; Aguilera Xiol, Eli ; Rigol, Montserrat ; Roca, Ignasi ; Muñoz, Laura ; Luque, Nestor ; Esperatti, Mariano ; Saco, Maria Adela ; Ramirez, Jose ; Vila, Jordi ; Ferrer, Miguel ; Torres, Antoni. / Endotracheal tube biofilm translocation in the lateral Trendelenburg position. In: Critical Care. 2015 ; Vol. 19, No. 1.
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AU - Fernandez-Barat, Laia

AU - Saucedo, Lina

AU - Giunta, Valeria

AU - Marti, Joan Daniel

AU - Tavares Ranzani, Otavio

AU - Aguilera Xiol, Eli

AU - Rigol, Montserrat

AU - Roca, Ignasi

AU - Muñoz, Laura

AU - Luque, Nestor

AU - Esperatti, Mariano

AU - Saco, Maria Adela

AU - Ramirez, Jose

AU - Vila, Jordi

AU - Ferrer, Miguel

AU - Torres, Antoni

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N2 - 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.

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