The online version of this article (doi:10.1186/1471-2253-14-22) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
Conception and design: AC, GB, AP; data acquisition: AC, AB, RB, AL, SB, LA, RM; analysis and interpretation of data: AC, GB, SB, AP; manuscript drafting: AC, GB; article critical revision for important intellectual content: AC, GB, AB, RB, AL, SB, LA, RM, AP. All authors read and approved the final version of the manuscript. The presented research was funded by institutional funds from the Department of Health Sciences, University of Milan-Bicocca, Monza, Italy.
Biofilm accumulates within the endotracheal tube (ETT) early after intubation. Contaminated secretions in the ETT are associated with increased risk for microbial dissemination in the distal airways and increased resistance to airflow. We evaluated the effectiveness of micro computed tomography (MicroCT) for the quantification of ETT inner volume reduction in critically ill patients.
We injected a known amount of gel into unused ETT to simulate secretions. We calculated the volume of gel analyzing MicroCT scans for a length of 20 cm. We then collected eleven ETTs after extubation of critically ill patients, recording clinical and demographical data. We assessed the amount of secretions by MicroCT and obtained ETT microbiological cultures.
Gel volumes assessed by MicroCT strongly correlated with injected gel volumes (p < 0.001, r2 = 0.999).
MicroCT revealed the accumulation of secretions on all the ETTs (median 0.154, IQR:0.02-0.837 mL), corresponding to an average cross-sectional area reduction of 1.7%. The amount of secretions inversely correlated with patients’ age (p = 0.011, rho = −0.727) but not with days of intubation, SAPS2, PaO2/FiO2 assessed on admission. Accumulation of secretions was higher in the cuff region (p = 0.003). Microbial growth occurred in cultures from 9/11 ETTs, and did not correlate with secretions amount. In 7/11 cases the same microbes were identified also in tracheal aspirates.
MicroCT appears as a feasible and precise technique to measure volume of secretions within ETTs after extubation. In patients, secretions tend to accumulate in the cuff region, with high variability among patients.
Additional file 1: Is an Acrobat file containing the electronic supplementary materials for the Methods and Results sections of present study.(PDF 131 KB)
Additional file 2: Is an Acrobat file containing Figure E1 (Increase in resistance to airflow in a 7.5 mm ETT by increase of injected gel amount).(PDF 147 KB)
Additional file 3: Is an Acrobat file containing Table E1 (Patient’s demographics and clinical characteristics).(PDF 169 KB)
Additional file 4: Is an Acrobat file containing Figure E2 (Exemplary 3d-reconstruction of MicroCT scan of an ETT portion).(PDF 139 KB)
Additional file 5: Is an Acrobat file containing Figure E3 (Association between patient’s age and secretion amount present within the ETT).(PDF 185 KB)
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- Measurement of endotracheal tube secretions volume by micro computed tomography (MicroCT) scan: an experimental and clinical study
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