Evaluation of continuous aspiration of subglottic secretion in an in vivo study

Lorenzo Berra, Lorenzo De Marchi, Mauro Panigada, Zu Xi Yu, Andrea Baccarelli, Theodor Kolobow

Research output: Contribution to journalArticle

104 Citations (Scopus)

Abstract

Objective: Continuous aspiration subglottic secretions (CASS) is believed to lower the incidence ventilator-associated pneumonia. Animal studies to establish safety and efficacy of CASS have not been conducted. Design: Prospective randomized animal study. Setting: Animal-research facility at the U.S. National Institutes of Health. Subjects: Twenty-two sheep. Interventions: Sheep were randomized info three groups, In group C (control), eight sheep were kept prone, intubated with a standard endotracheal tube (ETT), and mechanically ventilated for 72 hrs with head and ETT elevated at an angle 30°. In group CASS-HU (CASS, head up), seven sheep were managed as group C and intubated with a Hi-Lo Evac, Mallinckrodt ETT (CASS suction kept at ≤20 mm Hg). In group CASS-HD (CASS, head down), seven sheep were kept prone with CASS, and the ETT and trachea were horizontal to promote spontaneous drainage of mucus from the EW. Measurements and results: The lower respiratory tract in the CASS-HU group was heavily colonized in all seven sheep (median 4.6 × 10 9, range, 1.5 ×10 6 to 7.9 ×10 9 colony-forming units/g), with a reduction of lung bacterial colonization compared with the C group (p = .05). In group CASS-HD, the lower respiratory tract was not colonized in six of seven sheep. One sheep showed low levels of bacterial growth (median, 0; range, 0-2.2 × 10 5), At autopsy, in all 14 sheep with CASS, we found tracheal mucosal injury of different degrees of severity at the level of the suction port of the EW. Conclusions: In group CASS-HU, regardless of finding a marginal decrease of the bacterial colonization of the lower airways, there was pervasive trachea-bronchial-lung bacterial colonization. Second, there was minimal, or absent, bacterial colonization when the orientation of the CASS ETT was at, or just below, horizontal. Third, there was widespread injury to tracheal mucosa/submucosa from the use of CASS. Note that results of studies conducted in an animal model are always difficult to extrapolate to tie clinical practice dys to anatomical and functional differences.

Original languageEnglish
Pages (from-to)2071-2078
Number of pages8
JournalCritical Care Medicine
Volume32
Issue number10
DOIs
Publication statusPublished - Oct 2004

Fingerprint

Sheep
Head
Suction
Trachea
Respiratory System
Ventilator-Associated Pneumonia
Lung
Wounds and Injuries
National Institutes of Health (U.S.)
Mucus
Drainage
Autopsy
Mucous Membrane
Stem Cells
Animal Models
Safety
Control Groups
Incidence
Growth

Keywords

  • Aspiration
  • Continuous aspiration of subglottic secretions
  • Endotracheal tube
  • Mechanical ventilation
  • Ventilator-associated pneumonia

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Evaluation of continuous aspiration of subglottic secretion in an in vivo study. / Berra, Lorenzo; De Marchi, Lorenzo; Panigada, Mauro; Yu, Zu Xi; Baccarelli, Andrea; Kolobow, Theodor.

In: Critical Care Medicine, Vol. 32, No. 10, 10.2004, p. 2071-2078.

Research output: Contribution to journalArticle

Berra, Lorenzo ; De Marchi, Lorenzo ; Panigada, Mauro ; Yu, Zu Xi ; Baccarelli, Andrea ; Kolobow, Theodor. / Evaluation of continuous aspiration of subglottic secretion in an in vivo study. In: Critical Care Medicine. 2004 ; Vol. 32, No. 10. pp. 2071-2078.
@article{267d7bee64c241db90de5d3d672f0b2c,
title = "Evaluation of continuous aspiration of subglottic secretion in an in vivo study",
abstract = "Objective: Continuous aspiration subglottic secretions (CASS) is believed to lower the incidence ventilator-associated pneumonia. Animal studies to establish safety and efficacy of CASS have not been conducted. Design: Prospective randomized animal study. Setting: Animal-research facility at the U.S. National Institutes of Health. Subjects: Twenty-two sheep. Interventions: Sheep were randomized info three groups, In group C (control), eight sheep were kept prone, intubated with a standard endotracheal tube (ETT), and mechanically ventilated for 72 hrs with head and ETT elevated at an angle 30°. In group CASS-HU (CASS, head up), seven sheep were managed as group C and intubated with a Hi-Lo Evac, Mallinckrodt ETT (CASS suction kept at ≤20 mm Hg). In group CASS-HD (CASS, head down), seven sheep were kept prone with CASS, and the ETT and trachea were horizontal to promote spontaneous drainage of mucus from the EW. Measurements and results: The lower respiratory tract in the CASS-HU group was heavily colonized in all seven sheep (median 4.6 × 10 9, range, 1.5 ×10 6 to 7.9 ×10 9 colony-forming units/g), with a reduction of lung bacterial colonization compared with the C group (p = .05). In group CASS-HD, the lower respiratory tract was not colonized in six of seven sheep. One sheep showed low levels of bacterial growth (median, 0; range, 0-2.2 × 10 5), At autopsy, in all 14 sheep with CASS, we found tracheal mucosal injury of different degrees of severity at the level of the suction port of the EW. Conclusions: In group CASS-HU, regardless of finding a marginal decrease of the bacterial colonization of the lower airways, there was pervasive trachea-bronchial-lung bacterial colonization. Second, there was minimal, or absent, bacterial colonization when the orientation of the CASS ETT was at, or just below, horizontal. Third, there was widespread injury to tracheal mucosa/submucosa from the use of CASS. Note that results of studies conducted in an animal model are always difficult to extrapolate to tie clinical practice dys to anatomical and functional differences.",
keywords = "Aspiration, Continuous aspiration of subglottic secretions, Endotracheal tube, Mechanical ventilation, Ventilator-associated pneumonia",
author = "Lorenzo Berra and {De Marchi}, Lorenzo and Mauro Panigada and Yu, {Zu Xi} and Andrea Baccarelli and Theodor Kolobow",
year = "2004",
month = "10",
doi = "10.1097/01.CCM.0000142575.86468.9B",
language = "English",
volume = "32",
pages = "2071--2078",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

TY - JOUR

T1 - Evaluation of continuous aspiration of subglottic secretion in an in vivo study

AU - Berra, Lorenzo

AU - De Marchi, Lorenzo

AU - Panigada, Mauro

AU - Yu, Zu Xi

AU - Baccarelli, Andrea

AU - Kolobow, Theodor

PY - 2004/10

Y1 - 2004/10

N2 - Objective: Continuous aspiration subglottic secretions (CASS) is believed to lower the incidence ventilator-associated pneumonia. Animal studies to establish safety and efficacy of CASS have not been conducted. Design: Prospective randomized animal study. Setting: Animal-research facility at the U.S. National Institutes of Health. Subjects: Twenty-two sheep. Interventions: Sheep were randomized info three groups, In group C (control), eight sheep were kept prone, intubated with a standard endotracheal tube (ETT), and mechanically ventilated for 72 hrs with head and ETT elevated at an angle 30°. In group CASS-HU (CASS, head up), seven sheep were managed as group C and intubated with a Hi-Lo Evac, Mallinckrodt ETT (CASS suction kept at ≤20 mm Hg). In group CASS-HD (CASS, head down), seven sheep were kept prone with CASS, and the ETT and trachea were horizontal to promote spontaneous drainage of mucus from the EW. Measurements and results: The lower respiratory tract in the CASS-HU group was heavily colonized in all seven sheep (median 4.6 × 10 9, range, 1.5 ×10 6 to 7.9 ×10 9 colony-forming units/g), with a reduction of lung bacterial colonization compared with the C group (p = .05). In group CASS-HD, the lower respiratory tract was not colonized in six of seven sheep. One sheep showed low levels of bacterial growth (median, 0; range, 0-2.2 × 10 5), At autopsy, in all 14 sheep with CASS, we found tracheal mucosal injury of different degrees of severity at the level of the suction port of the EW. Conclusions: In group CASS-HU, regardless of finding a marginal decrease of the bacterial colonization of the lower airways, there was pervasive trachea-bronchial-lung bacterial colonization. Second, there was minimal, or absent, bacterial colonization when the orientation of the CASS ETT was at, or just below, horizontal. Third, there was widespread injury to tracheal mucosa/submucosa from the use of CASS. Note that results of studies conducted in an animal model are always difficult to extrapolate to tie clinical practice dys to anatomical and functional differences.

AB - Objective: Continuous aspiration subglottic secretions (CASS) is believed to lower the incidence ventilator-associated pneumonia. Animal studies to establish safety and efficacy of CASS have not been conducted. Design: Prospective randomized animal study. Setting: Animal-research facility at the U.S. National Institutes of Health. Subjects: Twenty-two sheep. Interventions: Sheep were randomized info three groups, In group C (control), eight sheep were kept prone, intubated with a standard endotracheal tube (ETT), and mechanically ventilated for 72 hrs with head and ETT elevated at an angle 30°. In group CASS-HU (CASS, head up), seven sheep were managed as group C and intubated with a Hi-Lo Evac, Mallinckrodt ETT (CASS suction kept at ≤20 mm Hg). In group CASS-HD (CASS, head down), seven sheep were kept prone with CASS, and the ETT and trachea were horizontal to promote spontaneous drainage of mucus from the EW. Measurements and results: The lower respiratory tract in the CASS-HU group was heavily colonized in all seven sheep (median 4.6 × 10 9, range, 1.5 ×10 6 to 7.9 ×10 9 colony-forming units/g), with a reduction of lung bacterial colonization compared with the C group (p = .05). In group CASS-HD, the lower respiratory tract was not colonized in six of seven sheep. One sheep showed low levels of bacterial growth (median, 0; range, 0-2.2 × 10 5), At autopsy, in all 14 sheep with CASS, we found tracheal mucosal injury of different degrees of severity at the level of the suction port of the EW. Conclusions: In group CASS-HU, regardless of finding a marginal decrease of the bacterial colonization of the lower airways, there was pervasive trachea-bronchial-lung bacterial colonization. Second, there was minimal, or absent, bacterial colonization when the orientation of the CASS ETT was at, or just below, horizontal. Third, there was widespread injury to tracheal mucosa/submucosa from the use of CASS. Note that results of studies conducted in an animal model are always difficult to extrapolate to tie clinical practice dys to anatomical and functional differences.

KW - Aspiration

KW - Continuous aspiration of subglottic secretions

KW - Endotracheal tube

KW - Mechanical ventilation

KW - Ventilator-associated pneumonia

UR - http://www.scopus.com/inward/record.url?scp=5644275044&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=5644275044&partnerID=8YFLogxK

U2 - 10.1097/01.CCM.0000142575.86468.9B

DO - 10.1097/01.CCM.0000142575.86468.9B

M3 - Article

VL - 32

SP - 2071

EP - 2078

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 10

ER -