Chest
Clinical Investigations in Critical CarePatterns and Routes of Tracheobronchial Colonization in Mechanically Ventilated Patients: The Role of Nutritional Status in Colonization of the Lower Airway by Pseudomonas Species
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Patients
Patients admitted to the medical intensive care unit at Winthrop-University Hospital were eligible for this study if they required endotracheal intubation and mechanical ventilation for the treatment of respiratory, neuromuscular, or cardiovascular disease. To be included in the study, patients had to give informed consent and to remain on mechanical ventilation for a minimum of one week. Individuals were excluded if, at the time of endotracheal intubation, they had a diagnosis of an acute
Frequency of Colonization at the Two Respiratory Tract Sites
A total of 75 sets of paired cultures were collected simultaneously and serially from both the buccal mucosa and tracheobronchial tree of the 14 subjects. Enteric Gram-negative bacteria (EGNB) were present in the initial lower respiratory tract culture in three of the 14 subjects. EGNB were found at least once in the tracheobronchial cultures of 11 subjects, while three subjects were never colonized during the study. In nine of these 11 colonized individuals, Pseudomonas sp were present, while
DISCUSSION
Respiratory tract colonization is common in hospitalized patients, with a frequency that parallels the degree of underlying illness in a given individual.12 Among critically ill patients treated with endotracheal intubation and mechanical ventilation, such colonization becomes more prominent as time in the intensive care unit increases and frequently culminates in the development of nosocomial pneumonia.3,6 In studies of critically ill patients, tracheobronchial colonization by enteric
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Cited by (126)
Ventilator-associated pneumonia: The central role of transcolonization
2019, Journal of Critical CareCitation Excerpt :The temporality of oral, pharyngeal, and digestive tract bacterial colonization is variable, and depends on the studies and observations. This apparent discrepancy may be based on the microbial agents involved [26,37,38,59], notably the presence of non-fermenting Gram negative bacilli [44] which are usually primarily found in tracheobronchial tree. However, in most situations the changes in the upper airways constitute the initial event, followed by tracheobronchial colonization.
The gastrointestinal immune system: Implications for the surgical patient
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Assistant Professor of Medicine, SUNY, Stony Brook.
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Instructor in Medicine, SUNY, Stony Brook.
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Associate Professor of Medicine, SUNY, Stony Brook.