Ventilator-Associated Pneumonia (VAP) is a Healthcare Associated Infection (HAI) (Fernandez, Levine, & Restrepo, 2012). It is caused by bacterial infections that develop during mechanical ventilation using an endotracheal tube. VAP is associated with high morbidity and mortality rates (Rosenblatt, Reitzel, Jiang, Hachem, & Raad, 2014). The following is an experiential study on measures to prevent VAP by use of antimicrobial-cuffed endotracheal tubes (ETT).
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Model for Prevention of VAP
Rosenblatt et al. (2014) developed an in-vitro model using various cuffed endotracheal tubes. The study examined the proliferation of microbes in the endotracheal tubes distal tip and the secretions of micro-aspirations past the cuffed part of the mechanical endotracheal tubes. The pathogens studied included Staphylococcus aureus and Pseudomonas aeruginosa. The endotracheal tubes used included:
- Standard polyvinyl chloride ETT: The tube acted as a control measure in the experiment. The specification for the tube included OD of 24 mm inflated cuff.
- Advanced endotracheal tube: The specification of the tube was OD of 26 mm inflated cuff. In addition, the ETT included polyurethane softly tapered cuff that had subglottic suctioning.
- Standard polyvinylchloride ETT: Gendine was used to treat the standard ETT on the shaft and the inflated cuff.
The investigation of the actions of pneumonia-causing bacteria involved pipetting the fluid inoculated with the pathogens of Staphylococcus aerus and Pseudomonas aeruginosa above the ETT cuff (Rosenblatt et al., 2014). The bacteria’s ability to colonize the cuffs of endotracheal tubes was independently tested. The pressure in the three cuffs was regularly measured and adjusted to avoid pressure difference (Rosenblatt et al., 2014). Statistical analysis tools were used for the analysis of the concentration of the bacterial formation around the cuff and below the cuff in the three different endotracheal tubes. SAS version 0.3 was used to analyze the concentration of bacteria in the endotracheal tubes.
Results and Analysis
In the micro-aspiration experiment model, the three endotracheal tubes did not control transmission of bacteria to the lower compartment of the model lungs. In the gendine ETT, it was found that the fluid appearing above the cuff was disinfected after the delay of microaspiration. Hence, the pathogens were not transmitted to the lower lungs. In the proliferation mode, the gendine ETT was the only experiment in which transmission was prevented (Rosenblatt et al., 2014). The findings demonstrated that the transmission of the pathogens depended entirely on the delay time of microaspiration and the potency of the ETT.
The use of standard polyvinyl chloride ETT as a control case study ensured that points of difference were established in the in-vitro experiment. However, the use of in-vitro model experiment meant that the reactions in the normal physiological process that contribute to VAP were not considered. The study depended only on the two types of bacterial incolutions that account for 70% of VAP (Rosenblatt et al., 2014). Thus, there is still need for more investigation that put into consideration the other factors such as the personal oral hygiene in the prevention of VAP.
In conclusion, the decolonization of the microbes and disinfection of secretions above the endotracheal cuff prevent PSV in the intubated patients. The decolonization process should incorporate the use of materials that are not harmful to the normal functioning of the human body.
Fernandez, J., Levine, S. & Restrepo, M. (2012). Technologic advances in endotracheal tubes for prevention of ventilator-associated pneumonia. Chest, 142 (1), 231–238.
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Rosenblatt, J., Reitzel, R., Jiang, Y., Hachem, R. & Raad, I. (2014). Insights on the role of antimicrobial-cuffed endotracheal tubes in preventing trans-tracheal transmission of VAP pathogens from an In-vitro model of micro-aspiration and microbial proliferation. Biomed Research International, 1(1), 1-9.