VAP in trauma patients

[Ivan Hronek]

Intensive Care Med. 2008 Apr 17 [Epub ahead of print]
Related Articles, Links
 
Internally coated endotracheal tubes with silver sulfadiazine in polyurethane to prevent bacterial colonization: a clinical trial.

Berra L, Kolobow T, Laquerriere P, Pitts B, Bramati S, Pohlmann J, Marelli C, Panzeri M, Brambillasca P, Villa F, Baccarelli A, Bouthors S, Stelfox HT, Bigatello LM, Moss J, Pesenti A.

Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114, Boston, MA, USA, lberra at partners.org.

OBJECTIVE: Coated medical devices have been shown to reduce catheter-related infections. We coated endotracheal tubes (ETT) with silver sulfadiazine (SSD), and tested them in a clinical study to assess the feasibility, safety, and efficacy of preventing bacterial colonization. DESIGN: A prospective, randomized clinical trial, phase I-II. SETTING: Academic intensive care unit (ICU). PARTICIPANTS: Forty-six adult patients expected to need 12-24[Symbol: see text]h of intubation were randomized into two groups. INTERVENTIONS: Patients were randomized to be intubated with a standard non-coated ETT (St-ETT, n[Symbol: see text]=[Symbol: see text]23; control group), or with a SSD-coated ETT (SSD-ETT, n[Symbol: see text]=[Symbol: see text]23). MEASUREMENTS AND RESULTS: Coating with SSD prevented bacterial colonization of the ETT (frequency of colonization: SSD-ETT 0/23, St-ETT 8/23; p[Symbol: see text]<[Symbol: see text]0.01). No organized bacterial biofilm could
 be identified on the lumen of any ETT; however, SSD was associated with a thinner mucus layer (in the SSD-ETT secretion deposits ranged from 0 to 200[Symbol: see text]mum; in the St-ETT deposits ranged between 50 and 700[Symbol: see text]mum). No difference was observed between the two groups in the tracheobronchial brush samples (frequency of colonization: SSD-ETT 0/23, St-ETT 2/23; p[Symbol: see text]=[Symbol: see text]0.48). No adverse reactions were observed with the implementation of the novel device. CONCLUSION: SSD-ETT can be safely used in preventing bacterial colonization and narrowing of the ETT in patients intubated for up to 24[Symbol: see text]h (mean intubation time 16[Symbol: see text]h).


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http://www.chestjournal.org/cgi/content/full/121/3/863
Conclusion: These results suggest that the silver coating ofendotracheal tubes may delay the onset of and decrease the severityof lung colonization by aerobic bacteria. Based on these results,clinical studies are planned to determine the safety and clinicalefficacy of silver-coated endotracheal tubes in patients requiringmechanical ventilation in the ICU setting.

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http://clinicaltrials.gov/ct2/show/NCT00341354?intr=%22Silver+Sulfadiazine%22&rank=5

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http://www.wipo.int/pctdb/en/wo.jsp?IA=WO2005076895&DISPLAY=CLAIMS
Mucus shaving...

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http://linkinghub.elsevier.com/retrieve/pii/S0195670104001069Antiseptic ETTs prevented bacterial colonization in the airway model and also retained significant amounts of the antiseptic. These results indicate that the effectiveness of antiseptic-impregnated ETTs in preventing the growth of bacterial pathogens associated with VAP may vary with different organisms.

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http://www.unboundmedicine.com/medline/ebm/research/silver_sulfadiazine

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 Ivan Hronek MD
Los Angeles, CA
http://health.groups.yahoo.com/group/Anesthideas/
 
"We are what we repeatedly do.  Excellence, then, is not an act, but a habit."  Aristotle
PPlease don't print this e-mail unless you really need to.

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----- Original Message ----
From: "Schlenker, Anita" <Anita.Schlenker at tenethealth.com>
To: trauma-list at trauma.org
Sent: Monday, May 5, 2008 10:50:22 AM
Subject: VAP in trauma patients

Are any of you using internally coated endotracheal tubes with silver sulfadiazine to prevent VAP in your trauma patients? 
Anita Schlenker, RN
Trauma Program Manager
Doctors Medical Center - Modesto
1441 Florida Ave
Modesto, CA 95350
209-576-3776

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