Ventilator-Associated Pneumonia. Mucus Slurper. Mucucili

Heart, Lung, And Blood Institute

Investigators

Linked publications & trials

Abstract

1. The "Mucus Shaver" and "Mucus Slurper" We have previously developed a method to totally clean the lumen of the tracheal tube in intubated sheep through the use of a catheter mounted special inflatable balloon, with two or more "Shaving Rings" attached. In one sweep, the entire length of the ETT is free of all mucus (The Mucus Shaver). We have now modified a commercially available tracheal tube (the CASS tracheal tube, Mallinckrodt Inc.), to allow spontaneous, automatic, timed suctioning of mucus through multiple ports at the very distal tip of the endotracheal tube, lasting a few milliseconds - in the process removing all mucus/secretions as they reach the tip of such modified tracheal tube (The Mucus Slurper). This process is automatic, timed to activate a few milliseconds following start of the expiratory phase. This keeps the endotracheal tube free of mucus and secretions and dispenses with the need for periodic manual (and never completely efficient) tracheal/tracheal tube suctioning. 2. Mucuciliary Transport Based on our earlier studies, we had shown that the above, horizontal orientation (30 degrees) of the trachea/tracheal tube during mechanical ventilation in intubated sheep was the single variable that determined whether experimental animals (sheep) develop Ventilator Associated Pneumonia (VAP), (a practice now routinely applied to patients on a mechanical ventilator); while in laboratory studies in sheep, with the tracheal tube/trachea oriented at, or below horizontal, there was spontaneous drainage of mucus through the tracheal tube, without developing VAP. In now ongoing studies in sheep, we have shown that small, 1 mm tantalum discs (applies also to bacteria colonized mucus), insufflated into the mid-trachea in sheep, with the trachea/tracheal tube oriented just below horizontal, spontaneously travel in an outward direction towards the mouth; while tantalum discs insufflated with the trachea/tracheal tube, and the head/trunk in the now clinically preferred semi-recumbent position (both elevated 30 degrees above horizontal), moves in the retrograde direction - towards the lungs. The latter process is associated with very high/certain probability of VAP. We hence conclude that VAP in the intubated patient is an avoidable disease, provided those newfound lessons are applied in full.