Journal
INTENSIVE CARE MEDICINE
Volume 38, Issue 4, Pages 677-685Publisher
SPRINGER
DOI: 10.1007/s00134-012-2495-2
Keywords
Mechanical ventilation; Pneumonia; Ventilator-associated pneumonia; Semirecumbent position; Intubation; Postural drainage; Pulmonary; Pigs; Nosocomial infections; Respiration; Artificial/adverse effects; Intratracheal/adverse effects; Respiratory tract infections/prevention and control; Aspiration/prevention and control
Categories
Funding
- Intramural NIH HHS Funding Source: Medline
Ask authors/readers for more resources
Orientation of the trachea and tracheal tube below horizontal may prevent aspiration of oropharyngeal secretions into the lungs, which is a pivotal pathway in the pathogenesis of ventilator-associated pneumonia (VAP). The incidence of VAP was evaluated in swine with orientation of trachea and tracheal tube above horizontal (model of semirecumbent position, currently recommended in patients) and below horizontal. Twenty-six mini-pigs were randomized into four groups: (A) eight mechanically ventilated with orientation of trachea 45A degrees above horizontal for 72 h. In the remaining groups (B, C, D) the trachea was oriented 10A degrees below horizontal, with (B) six mechanically ventilated for 72 h, (C) six mechanically ventilated for 72 h with enteral feeding, and (D) six mechanically ventilated for 168 h with enteral feeding. At the end of the study period, all pigs were sacrificed and the clinical diagnosis of VAP was microbiologically evaluated. No antibiotics were administered. All eight pigs kept orientated with the trachea 45A degrees above horizontal developed VAP and respiratory failure (PaO2/FiO2 = 132 +/- A 139 mmHg) with a median of 5.5 pulmonary lobes out of 6 colonized with average colonization of 9.3 x 10(7) CFU/g. None of the 18 pigs kept oriented with the trachea below horizontal developed VAP; 16 had sterile lungs, while 2, ventilated for 7 days, developed a low level of colonization. Orientation of the trachea above horizontal was uniformly associated with VAP and respiratory failure; positioning the trachea below horizontal consistently prevented development of VAP.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available