Abstract
Biofilm formation in tracheal tubes, its bacterial content, and its interaction with ventilator gas flow were investigated. At least 50 mg (dry weight) of biofilm was found in 30 of 40 tracheal tubes used in intensive care patients for 2 h to 10 days. Electron microscopy showed bacteria in this layer, and quantitative studies showed that bacterial counts could reach up to 10(6)/cm of tube length. Bacteria were cultured from the patient side of 18 of 78 heat and moisture exchanger-microbiological filter units removed from ventilator circuits. Particles were shown to detach from tracheal tube luminal biofilm and were projected up to 45 cm from the tracheal tube tip. Following contamination of the tracheal tube biofilm with a patient's own gastrointestinal flora, entrainment of bacteria in the inspiratory gas flow provides a mechanism for initial and repeated lung colonization.
Full text
PDF




Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Ansfield M. J., Woods D. E., Johanson W. G., Jr Lung bacterial clearance in murine pneumococcal pneumonia. Infect Immun. 1977 Jul;17(1):195–204. doi: 10.1128/iai.17.1.195-204.1977. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Atherton S. T., White D. J. Stomach as source of bacteria colonising respiratory tract during artificial ventilation. Lancet. 1978 Nov 4;2(8097):968–969. doi: 10.1016/s0140-6736(78)92530-8. [DOI] [PubMed] [Google Scholar]
- Cash H. A., Woods D. E., McCullough B., Johanson W. G., Jr, Bass J. A. A rat model of chronic respiratory infection with Pseudomonas aeruginosa. Am Rev Respir Dis. 1979 Mar;119(3):453–459. doi: 10.1164/arrd.1979.119.3.453. [DOI] [PubMed] [Google Scholar]
- Craven D. E., Kunches L. M., Kilinsky V., Lichtenberg D. A., Make B. J., McCabe W. R. Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis. 1986 May;133(5):792–796. [PubMed] [Google Scholar]
- Cross A. S., Roup B. Role of respiratory assistance devices in endemic nosocomial pneumonia. Am J Med. 1981 Mar;70(3):681–685. doi: 10.1016/0002-9343(81)90596-9. [DOI] [PubMed] [Google Scholar]
- Driks M. R., Craven D. E., Celli B. R., Manning M., Burke R. A., Garvin G. M., Kunches L. M., Farber H. W., Wedel S. A., McCabe W. R. Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers. The role of gastric colonization. N Engl J Med. 1987 Nov 26;317(22):1376–1382. doi: 10.1056/NEJM198711263172204. [DOI] [PubMed] [Google Scholar]
- Geesey G. G., Richardson W. T., Yeomans H. G., Irvin R. T., Costerton J. W. Microscopic examination of natural sessile bacterial populations from an alpine stream. Can J Microbiol. 1977 Dec;23(12):1733–1736. doi: 10.1139/m77-249. [DOI] [PubMed] [Google Scholar]
- Larson E. Bacterial colonization of tracheal tubes of patients in a surgical intensive care unit. Nurs Res. 1970 Mar-Apr;19(2):122–128. [PubMed] [Google Scholar]
- Ledingham I. M., Alcock S. R., Eastaway A. T., McDonald J. C., McKay I. C., Ramsay G. Triple regimen of selective decontamination of the digestive tract, systemic cefotaxime, and microbiological surveillance for prevention of acquired infection in intensive care. Lancet. 1988 Apr 9;1(8589):785–790. doi: 10.1016/s0140-6736(88)91656-x. [DOI] [PubMed] [Google Scholar]
- Mehta S. The risk of aspiration in presence of cuffed endotracheal tubes. Br J Anaesth. 1972 Jun;44(6):601–605. doi: 10.1093/bja/44.6.601. [DOI] [PubMed] [Google Scholar]
- Sottile F. D., Marrie T. J., Prough D. S., Hobgood C. D., Gower D. J., Webb L. X., Costerton J. W., Gristina A. G. Nosocomial pulmonary infection: possible etiologic significance of bacterial adhesion to endotracheal tubes. Crit Care Med. 1986 Apr;14(4):265–270. [PubMed] [Google Scholar]
- Stevens R. M., Teres D., Skillman J. J., Feingold D. S. Pneumonia in an intensive care unit. A 30-month experience. Arch Intern Med. 1974 Jul;134(1):106–111. [PubMed] [Google Scholar]
- du Moulin G. C., Paterson D. G., Hedley-Whyte J., Lisbon A. Aspiration of gastric bacteria in antacid-treated patients: a frequent cause of postoperative colonisation of the airway. Lancet. 1982 Jan 30;1(8266):242–245. doi: 10.1016/s0140-6736(82)90974-6. [DOI] [PubMed] [Google Scholar]