title: Tracheal tube biofilm removal through a novel closed-suctioning system: an experimental study.
abstract: BACKGROUND
  Tracheal tube biofilm develops during mechanical ventilation. We compared a novel closed-suctioning system vs standard closed-suctioning system in the prevention of tracheal tube biofilm.
  
  
  METHODS
  Eighteen pigs, on mechanical ventilation for 76 h, with P. aeruginosa pneumonia were randomized to be tracheally suctioned via the KIMVENT* closed-suctioning system (control group) or a novel closed-suctioning system (treatment group), designed to remove tracheal tube biofilm through saline jets and an inflatable balloon. Upon autopsy, two tracheal tube hemi-sections were dissected for confocal and scanning electron microscopy. Biofilm area, maximal and minimal thickness were computed. Biofilm stage was assessed.
  
  
  RESULTS
  Sixteen animals were included in the final analysis. In the treatment and control group, the mean (sd) pulmonary burden was 3.34 (1.28) and 4.17 (1.09) log cfu gr(-1), respectively (P=0.18). Tracheal tube P. aeruginosa colonization was 5.6 (4.9-6.3) and 6.2 (5.6-6.9) cfu ml(-1) (median and interquartile range) in the treatment and control group, respectively (P=0.23). In the treatment group, median biofilm area was 3.65 (3.22-4.21) log10 μm2 compared with 4.49 (4.27-4.52) log10 μm2 in the control group (P=0.031). In the treatment and control groups, the maximal biofilm thickness was 48.3 (26.7-71.2) µm (median and interquartile range) and 88.8 (43.8-125.7) µm, respectively. The minimal thickness in the treatment and control group was 0.6 (0-4.0) µm and 23.7 (5.3-27.8) µm (P=0.040) (P=0.017). Earlier stages of biofilm development were found in the treatment group (P<0.001).
  
  
  CONCLUSIONS
  The novel CSS reduces biofilm accumulation within the tracheal tube. A clinical trial is required to confirm these findings and the impact on major outcomes.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Aguilera Xiol
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain University of Barcelona, Barcelona, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Li Bassi
authors.affiliation: Critical Care Unit, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: Wyncoll
authors.affiliation: Critical Care Unit, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom Physiotherapy Department, Guy's & St Thomas' NHS Foundation Trust, United Kingdom School of Physiotherapy, Australian Catholic University, North Sydney Campus, North Sydney, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Ntoumenopoulos
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Fernandez-Barat
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain.
authors.forename: J D
authors.initials: JD
authors.lastname: Marti
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Comaru
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain University of Milan, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: De Rosa
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain Department of Cardiology, Hospital Clinic, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Rigol
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Rinaudo
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain University of Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Ferrer
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain University of Barcelona, Barcelona, Spain atorres@clinic.ub.es.
authors.forename: A
authors.initials: A
authors.lastname: Torres
mesh_terms: D000818:Animals; D018441:Biofilms; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D018613:Microscopy, Confocal; D018410:Pneumonia, Bacterial / Q000517:prevention & control / Q000635:transmission; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D016459:Prosthesis-Related Infections / Q000517:prevention & control*; D011552:Pseudomonas Infections / Q000517:prevention & control / Q000635:transmission; D011550:Pseudomonas aeruginosa; D013396:Suction / Q000379:methods; D034421:Sus scrofa
keywords: biofilms; catheters; intubation intratracheal; pneumonia