title: Reduction of the bacterial load by the silver-coated endotracheal tube (SCET), a laboratory investigation.
abstract: Microaspiration enabled by high-volume-low-pressure cuffed endotracheal tubes is the most likely explanation for ventilator-associated pneumonia. To decontaminate the secretion at the proximal end of the cuff we developed a silver-coated endotracheal tube (SCET). In an in vitro model we investigated the efficacy of SCET to lower the bacterial load of secretion and aspirate. We developed a continuously contaminated and mechanically ventilated oropharynx-larynx-lung model to investigate the reduction of the bacterial count by SCET compared to controls. The model was continuously contaminated via the oropharynx-larynx with Pseudomonas aeruginosa ATCC 27853. During the investigation period of 50 hours the bacterial count of oropharynx-larynx and lung was measured as colony-forming-units/ml. In addition, the characteristic curve of silver ion release of SCET was determined. SCET significantly reduced the bacterial count in oropharynx-larynx at all timepoints (p < 0.05). In lung the bacterial count was significantly lower beginning with the 36th hour of recording (p < 0.05). A reduction of greater than 2 log was found from 28 hours on in oropharynx-larynx and from 50 hours on in lung. The release of silver ions was very rapid and was described by a mono-exponential function with a time-constant tau of about 60 minutes and a saturation concentration of 200 +/- 80 microg/l. SCET showed a significant inhibition of growth of P. aeruginosa in the continuously contaminated and mechanically ventilated oropharynx-larynx-lung model. SCET by thus might be helpful in reducing ventilator-associated pneumonia.
authors.affiliation: Clinic of Anaesthesiology, Freiburg University Hospital, Germany. hartmann@ana1.ukl.uni-freiburg.de
authors.forename: M
authors.initials: M
authors.lastname: Hartmann
authors.forename: J
authors.initials: J
authors.lastname: Guttmann
authors.forename: B
authors.initials: B
authors.lastname: Müller
authors.forename: T
authors.initials: T
authors.lastname: Hallmann
authors.forename: K
authors.initials: K
authors.lastname: Geiger
mesh_terms: D001424:Bacterial Infections / Q000517:prevention & control* / Q000635:transmission*; D004866:Equipment Contamination / Q000517:prevention & control*; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008954:Models, Biological; D011014:Pneumonia / Q000209:etiology* / Q000517:prevention & control; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D012121:Respiration, Artificial / Q000009:adverse effects*; D012834:Silver / Q000627:therapeutic use*
chemical_list: D012834:Silver