title: Incidence of endotracheal tube colonization with the use of PneuX endotracheal tubes in patients following cardiac surgery.
abstract: BACKGROUND
  Ventilator-associated pneumonia (VAP) develops in up to 25% of patients following cardiac surgery. Colonization of the endotracheal tube (ETT) contributes to VAP. The PneuX ETT has been shown to halve VAP in high-risk patients undergoing cardiac surgery. This article reports on the secondary analysis of bacterial colonization in relation to VAP between the PneuX and standard ETTs.
  
  
  METHODS
  In this randomized controlled trial, patients were randomized on a 1:1 basis to Group A (PneuX ET, N=120) or Group B (standard ETT, N=120). Patients aged >70 years with or without impaired left ventricular function (<50%) undergoing elective and urgent cardiac surgery were included in this study. Incidence of postoperative VAP and analysis of bacterial colonization within the ETT (N=234) were measured for patients requiring <24 h, 24-48 h and >48 h of intubation.
  
  
  RESULTS
  Baseline patient demographics were comparable. VAP was lower in Group A compared with Group B (10.8% vs 21%; P=0.03). The incidence of VAP was lower at each time point for Group A. There was a lower incidence of ETT colonization in Group A for patients needing >48 h of intubation. There was no difference in the type of bacterial colonization (P=0.5) or the mean number of colony-forming units [4.35x107(1.18x108) and 2.16x108(1.24x109) in Groups A and B, respectively (P=0.8)].
  
  
  CONCLUSIONS
  Colonization of the ETT does not seem to play an important role in early-onset VAP. There is a tendency for reduced colonization in the PneuX ETT with longer intubation times. This may have an impact on reducing the incidence of late-onset VAP.
authors.affiliation: Department of Cardiothoracic Surgery, Heart and Lung Centre, Wolverhampton, UK. Electronic address: eshansenanayake@nhs.net.uk.
authors.forename: E L
authors.initials: EL
authors.lastname: Senanayake
authors.affiliation: Department of Cardiothoracic Anaesthesia, Heart and Lung Centre, Wolverhampton, UK.
authors.forename: R
authors.initials: R
authors.lastname: Giri
authors.affiliation: Department of Intensive Care, Heart and Lung Centre, Wolverhampton, UK.
authors.forename: S
authors.initials: S
authors.lastname: Gopal
authors.affiliation: University of Wolverhampton, Wolverhampton, UK.
authors.forename: A
authors.initials: A
authors.lastname: Nevill
authors.affiliation: Department of Cardiothoracic Surgery, Heart and Lung Centre, Wolverhampton, UK.
authors.forename: H
authors.initials: H
authors.lastname: Luckraz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000302:isolation & purification*; D004864:Equipment and Supplies / Q000382:microbiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D013903:Thoracic Surgery
keywords: Cardiac surgery; Microbial colonization; PneuX endotracheal tube; Ventilator-associated pneumonia