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 language | English |
|---|---|
| Pages (from-to) | 2071-2078 |
| Number of pages | 8 |
| Journal | Critical Care Medicine |
| Volume | 32 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - Oct 2004 |
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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 journal › Article
}
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
C2 - 15483416
AN - SCOPUS:5644275044
VL - 32
SP - 2071
EP - 2078
JO - Critical Care Medicine
JF - Critical Care Medicine
SN - 0090-3493
IS - 10
ER -