title: Endotracheal tube biofilm translocation in the lateral Trendelenburg position.
abstract: BACKGROUND
  Laboratory studies demonstrated that the lateral Trendelenburg position (LTP) is superior to the semirecumbent position (SRP) in the prevention of ventilator-associated pulmonary infections. We assessed whether the LTP could also prevent pulmonary colonization and infections caused by an endotracheal tube (ETT) biofilm.
  
  
  METHODS
  Eighteen pigs were intubated with ETTs colonized by Pseudomonas aeruginosa biofilm. Pigs were positioned in LTP and randomized to be on mechanical ventilatin (MV) up to 24 hour, 48 hour, 48 hour with acute lung injury (ALI) by oleic acid and 72 hour. Bacteriologic and microscopy studies confirmed presence of biofilm within the ETT. Upon autopsy, samples from the proximal and distal airways were excised for P.aeruginosa quantification. Ventilator-associated tracheobronchitis (VAT) was confirmed by bronchial tissue culture ≥3 log colony forming units per gram (cfu/g). In pulmonary lobes with gross findings of pneumonia, ventilator-associated pneumonia (VAP) was confirmed by lung tissue culture ≥3 log cfu/g.
  
  
  RESULTS
  P.aeruginosa colonized the internal lumen of 16 out of 18 ETTs (88.89%), and a mature biofilm was consistently present. P.aeruginosa colonization did not differ among groups, and was found in 23.6% of samples from the proximal airways, and in 7.1% from the distal bronchi (P = 0.001). Animals of the 24 hour group never developed respiratory infections, whereas 20%, 60% and 25% of the animals in group 48 hour, 48 hour-ALI and 72 hour developed P.aeruginosa VAT, respectively (P = 0.327). Nevertheless, VAP never developed.
  
  
  CONCLUSIONS
  Our findings imply that during the course of invasive MV up to 72 hour, an ETT P.aeruginosa biofilm hastily colonizes the respiratory tract. Yet, the LTP compartmentalizes colonization and infection within the proximal airways and VAP never develops.
authors.affiliation: Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. glibassi@clinic.ub.es.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. glibassi@clinic.ub.es.|Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain. glibassi@clinic.ub.es.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Li Bassi
authors.affiliation: Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. LFERNAN1@clinic.ub.es.|Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain. LFERNAN1@clinic.ub.es.
authors.forename: Laia
authors.initials: L
authors.lastname: Fernandez-Barat
authors.affiliation: Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. linasaucedo@hotmail.com.|Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain. linasaucedo@hotmail.com.
authors.forename: Lina
authors.initials: L
authors.lastname: Saucedo
authors.affiliation: University of Milan, Milan, Italy. valeria.giunta@gmail.com.
authors.forename: Valeria
authors.initials: V
authors.lastname: Giunta
authors.affiliation: Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. jd.martibcn@gmail.com.|Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain. jd.martibcn@gmail.com.
authors.forename: Joan Daniel
authors.initials: JD
authors.lastname: Marti
authors.affiliation: Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. otavioranzani@yahoo.com.br.|Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain. otavioranzani@yahoo.com.br.|Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Pulmonary Intensive Care Unit, São Paulo, Brazil. otavioranzani@yahoo.com.br.
authors.forename: Otavio
authors.initials: O
authors.lastname: Tavares Ranzani
authors.affiliation: Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. eli_agui@hotmail.com.|Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain. eli_agui@hotmail.com.
authors.forename: Eli
authors.initials: E
authors.lastname: Aguilera Xiol
authors.affiliation: Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. montserrat.rigol@idibaps.org.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. montserrat.rigol@idibaps.org.|Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain. montserrat.rigol@idibaps.org.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Rigol
authors.affiliation: Department of Clinical Microbiology, School of Medicine, and Barcelona Centre for International Health Research, (CRESIB) Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. IGROCA@clinic.ub.es.
authors.forename: Ignasi
authors.initials: I
authors.lastname: Roca
authors.affiliation: Department of Clinical Microbiology, School of Medicine, and Barcelona Centre for International Health Research, (CRESIB) Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. eslaura_1812@hotmail.com.
authors.forename: Laura
authors.initials: L
authors.lastname: Muñoz
authors.affiliation: Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. nesmedic@hotmail.com.
authors.forename: Nestor
authors.initials: N
authors.lastname: Luque
authors.affiliation: Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. marianoesperatti@gmail.com.
authors.forename: Mariano
authors.initials: M
authors.lastname: Esperatti
authors.affiliation: Pathology Department, Hospital Clinic, Barcelona, Spain. MASACO@clinic.ub.es.
authors.forename: Maria Adela
authors.initials: MA
authors.lastname: Saco
authors.affiliation: Pathology Department, Hospital Clinic, Barcelona, Spain. JRAMIREZ@clinic.ub.es.
authors.forename: Jose
authors.initials: J
authors.lastname: Ramirez
authors.affiliation: Department of Clinical Microbiology, School of Medicine, and Barcelona Centre for International Health Research, (CRESIB) Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. JVILA@clinic.ub.es.|University of Barcelona, Barcelona, Spain. JVILA@clinic.ub.es.
authors.forename: Jordi
authors.initials: J
authors.lastname: Vila
authors.affiliation: Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. MIFERRER@clinic.ub.es.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. MIFERRER@clinic.ub.es.|Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain. MIFERRER@clinic.ub.es.
authors.forename: Miguel
authors.initials: M
authors.lastname: Ferrer
authors.affiliation: Pulmonary and Critical Care Unit, Hospital Clínic, Calle Villarroel 170, Esc 6/8 Planta 2, 08036, Barcelona, Spain. atorres@clinic.ub.es.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. atorres@clinic.ub.es.|Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Mallorca, Spain. atorres@clinic.ub.es.|University of Barcelona, Barcelona, Spain. atorres@clinic.ub.es.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
mesh_terms: D000818:Animals; D001422:Bacterial Adhesion; D018441:Biofilms; D001991:Bronchitis / Q000382:microbiology; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008168:Lung / Q000382:microbiology; D018613:Microscopy, Confocal; D008855:Microscopy, Electron, Scanning; D023421:Models, Animal; D056888:Patient Positioning; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control; D013552:Swine; D014136:Tracheitis / Q000382:microbiology