Mucociliary Transport in ICU Patients

Konrad, F; Schreiber, Torsten; Brecht-Kraus, Doris; Georgieff, Michael

doi:10.1378/chest.105.1.237

Cited by 202 publications

(144 citation statements)

References 29 publications

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“…The ETT reduces tracheobronchial mucus flow by half, resulting in retained secretions and the development of pneumonia. 3,4 VAP is caused primarily by microaspiration of infected oropha-ryngeal secretions pooled above the ETT cuff and represents the most important infectious challenge in the critical care setting. 5 Both the incidence of VAP and attributable mortality are difficult to discern, but are estimated to occur in 9 -28% of mechanically ventilated patients, 6 with an attributable mortality of 3-17%.…”

Section: Introductionmentioning

confidence: 99%

The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science

Kallet

2015

Respir Care

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SummaryVentilator-associated pneumonia (VAP) is an acquired infection related primarily to the consequences of prolonged endotracheal intubation. It is considered the most important infectious challenge in the critical care setting. Preventable complications of hospital care are considered an important source of wasted health-care costs believed to consume up to 47% of annual expenditures in the United States. Whether VAP is preventable has become a highly contentious debate since public reporting commenced a decade ago. This selective review focuses on specific aspects of this debate, including the inherent vagaries in the diagnosis of VAP and the marked disparities between VAP rates based on clinical diagnosis versus surveillance data. Also discussed is how this debate has impacted public policy, leading to the new paradigm of ventilator-associated events. The limited ability of artificial airways to prevent microaspiration and biofilm build-up, as well as non-modifiable conditions increasing the risk of VAP, is described in detail. In addition, the origins of the mistaken but widely embraced notion that zero VAP is a realistic achievement are examined.

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Section: Introductionmentioning

confidence: 99%

The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science

Kallet

2015

Respir Care

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“…Maintaining good hydration, humidification of inspired gases, chest physiotherapy and postural drainage combined with manual lung hyperinflation is considered a traditional and safe method for the prevention and treatment of atelectasis in the majority of patients [3,4]. Although studies have shown that chest physiotherapy alone is effective for the management of acute lobar atelectasis [5].…”

Section: Discussionmentioning

confidence: 99%

Lung Collapse in Intubated Patient is not Always because of Tube Factor?

Singhal¹

2012

J Clin Case Rep

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Case Summary50 year old male, diagnosed case of Chronic Obstructive Pulmonary Disease (COPD) was admitted to ICU as a case of cellulitis of left lower limb with septic shock and multi-organ dysfunction. On admission, he was managed with intravenous fluids, vasopressor (noradrenaline), broad spectrum antibiotics, nebulisation and mechanical ventilation. Gradually, he showed improvement clinically as well as in laboratory parameters. On fourth day, he became haemodynamically stable, maintaining oxygen saturation on minimal ventilatory support (Pressure Support mode) and was planned for extubation on the next day. But, he developed respiratory distress (respiratory rate 35/minute, use of accessory muscle present) while on Pressure Support Ventilation along with hypoxemia. He was immediately placed on control mode of mechanical ventilation with tidal volume of 350 ml (6 mls/kg) which showed high airway pressures (PIP>40 cm H2O) with every inspiratory effort. Suctioning of the endotracheal tube was done with a 12 Fr Gauge suction catheter by open method which could be negotiated up to the carina with minimal secretions being aspirated with poor cough reflex. Chest auscultation revealed diminished air entry on left side. The position of the tube was re-confirmed with direct laryngoscopy. Chest radiograph revealed collapse of left lung with endotracheal tube in situ and at proper position (Figure 1). In view of whole left lung collapse and worsening hypoxemia, immediately fibreoptic bronchoscopy was done which showed thick mucus plug in the left main bronchus which after toileting was removed, following which left lung fully expanded (Figure 2).

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“…1 Respiratory complications frequently occur in patients who are mechanically ventilated due to the presence of artificial airways 2,3 and sedation, 4 inadequate airway humidification, 5,6 impaired mucociliary clearance, 7 diminished cough, 8 and variable airway pressures. 9 All these factors have the potential to cause respiratory impairment 8,10 and exacerbate pre-morbid respiratory injury or disease.…”

Section: Introductionmentioning

confidence: 99%

Inter-Rater Agreement of Auscultation, Palpable Fremitus, and Ventilator Waveform Sawtooth Patterns Between Clinicians

2016

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BACKGROUND: Clinicians often use numerous bedside assessments for secretion retention in participants who are receiving invasive mechanical ventilation. This study aimed to evaluate interrater agreement between clinicians when using standard clinical assessments of secretion retention and whether differences in clinician experience influenced inter-rater agreement. METHODS: Seventy-one mechanically ventilated participants were assessed by a research clinician and by one of 13 ICU clinicians. Each clinician conducted a standardized assessment of lung auscultation, palpation for chest-wall (rhonchal) fremitus, and ventilator inspiratory/expiratory flow-time waveforms for the sawtooth pattern. RESULTS: On the presence of breath sounds, agreement ranged from absolute to moderate in the upper zones and the lower zones, respectively. Kappa values for abnormal and adventitious lung sounds achieved moderate agreement in the upper zones, less than chance agreement to substantial agreement in the middle zones, and moderate agreement to almost perfect agreement in the lower zones. Moderate to almost perfect agreement was established for palpable fremitus in the upper zones, moderate to substantial agreement in the middle zones, and less than chance to moderate agreement in the lower zones. Inter-rater agreement on the presence of expiratory sawtooth pattern identification showed moderate agreement. The level of percentage agreement between the research and ICU clinicians for each respiratory assessment studied did not relate directly to level of clinical experience. CONCLUSIONS: Inter-rater agreement for all assessments showed variability between lung regions but maintained reasonable percentage agreement in mechanically ventilated participants. The level of percentage agreement achieved between clinicians did not directly relate to clinical experience for all respiratory assessments. Therefore, these respiratory assessments should not necessarily be viewed in isolation but interpreted within the context of a full clinical assessment.

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Mucociliary Transport in ICU Patients

Cited by 202 publications

References 29 publications

The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science

The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science

Lung Collapse in Intubated Patient is not Always because of Tube Factor?

Inter-Rater Agreement of Auscultation, Palpable Fremitus, and Ventilator Waveform Sawtooth Patterns Between Clinicians

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