Efficacy of endotracheal tube suctioning in intubated intensive care unit patients determined by in vivo catheter-based optical coherence tomography—a pilot study

Quantitative Imaging in Medicine and Surgery

article

Stephen A. Boppart¹  Karen C. White⁵  Mark A. Johnson³  Eric J. Chaney¹  Guillermo L. Monroy¹  Ronit Barkalifa¹  Darold R. Spillman¹  Roshan Dsouza¹ 

[1] Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign;Department of Bioengineering, University of Illinois at Urbana-Champaign;Carle Illinois College of Medicine, University of Illinois at UrbanaChampaign;Department of Electrical and Computer Engineering, University of Illinois at UrbanaChampaign;Critical Care Medicine, Carle Foundation Hospital

关键词: Biofilms;    critical care medicine;    ventilator-associated pneumonia (VAP);    optical coherence tomography (OCT);   

DOI  :  10.21037/qims-20-549

学科分类：外科医学

来源: AME Publications

【 摘 要 】

Background: Mechanical ventilation using an endotracheal tube (ETT) is one of the critical interventions given to patients in the intensive care unit (ICU). ETTs are associated with the formation of biofilms, placing patients at increased risk for developing ventilator-associated pneumonia (VAP). ETT suctioning is used to remove secretions, reduce bacterial colonization, and reduce the rate of biofilm formation. However, current standard-of-care suctioning procedures do not adequately eliminate all secretions from the ETT. Methods: This observational study was conducted in a cohort of 4 subjects admitted to the ICU and intubated with an ETT, irrespective of ethnicity, gender, or race. A total of 23 suctioning procedures were evaluated with in vivo three-dimensional (3D) optical coherence tomography (OCT) imaging, before and after suctioning. A secretion density metric was derived from the OCT data to quantify the amount of secretions present within the ETT, and an attenuation coefficient metric was derived to detect and quantify the presence of biofilms. Analyzed OCT images were correlated with clinical and microscopy data. Results: Data obtained suggests that the current standard-of-care suctioning procedure is inefficient at clearing secretions or preventing the formation of biofilms. The presence of biofilms was corroborated with both post-intubation microscopy of the ETTs, as well as with clinical data. Conclusions: We conclude that the standard-of-care suctioning method does not eliminate secretions nor reduce the formation of biofilm in ETTs. Our in situ imaging method was sensitive to the presence of secretions, biofilms, and quantitative, and can be used for investigating different suctioning protocols in the future.

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