title: Endotracheal tube biofilm and ventilator-associated pneumonia with mechanical ventilation.
abstract: OBJECTIVE
  To analyze biofilm on internal and external surfaces of endotracheal tubes after their use in critical care patients, and to produce evidence of association between use of the tube, presence of biofilm, and the occurrence of pneumonia.
  
  
  METHODS
  This was a clinical study performed at the Intensive Care Unit of an emergency hospital in the interior of São Paulo state, Brazil. Data collection involved 30 endotracheal tubes used on adult patients for a period of ≥48 h of mechanical ventilation for scanning electron microscopy.
  
  
  RESULTS
  Analysis of the biofilm on the 30 tubes by scanning electron microscopy showed various abiotic and biotic structures, predominantly on the internal surface, such as: fibrin network, erythrocytes, leukocytes, cocci, bacilli, and molds, among others. The intubation period of the endotracheal tube for ≥8 days represented one of the risk factors for ventilator-associated pneumonia (RR 7.41, P < 0.001).
  
  
  CONCLUSIONS
  The presence of the endotracheal tube permits microbial colonization, overall contributing to the development of biofilm and the occurrence of pneumonia.
authors: Department of Nursing, University of Brasília, Brasília, Distrito Federal, Brazil.
authors: Paula Regina
authors: PR
authors: De Souza
authors: Denise
authors: D
authors: De Andrade
authors: Danielle Bezerra
authors: DB
authors: Cabral
authors: Evandro
authors: E
authors: Watanabe
mesh_terms: D001419:Bacteria / Q000302:isolation & purification / Q000648:ultrastructure; D018407:Bacterial Physiological Phenomena; D018441:Biofilms; D001938:Brazil; D004866:Equipment Contamination; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation; D053717:Pneumonia, Ventilator-Associated / Q000209:etiology / Q000382:microbiology* / Q000628:therapy; D012121:Respiration, Artificial / Q000009:adverse effects; D012122:Ventilators, Mechanical / Q000382:microbiology*
keywords: biofilms; cross-infection; intratracheal; intubation; pneumonia; ventilator-associated