Increased risks of endotracheal tube cuff colonization after prolonged intubation

Wen Hui Tsai, Hui Chi Hsu, Chung Hung Shih

Research output: Contribution to journalArticle

Abstract

Mechanical ventilation using endotracheal tube (ETT) intubation is crucial in saving life but may also cause ventilator-associated pneumonia resulting in morbidity and mortality. The purpose of this study was to examine the effects of intubation duration on pathogen colonization rates of ETT cuff region, and its association with the subsequent re-intubation and tracheostomy. We enrolled 92 patients who were successfully weaned from ventilator and were extubated within 20 days of intubation duration. Patients were divided into Group I and II based on intubation for 1-9 days and 10-20 days, respectively. Pathogen colonization over ETT cuff region and extra-cuff region (including sputum and ETT aspirates) were assessed. As compared to Group I patients, Group II patients had a significant higher pathogen colonization rate (100% vs. 69.2%; P <0.001) in the ETT cuff samples, but not in the extracuff samples (92.6% vs. 84.8%; P = 0.442). Further studies demonstrated that there was no difference between Group I and II patients in the percentages of patients with the same pathogen over both the cuff and extra-cuff samples (35.5% vs. 30.8%; P = 0.925), suggesting that the increased pathogen colonization rate over the ETT cuff region was least likely from the extra-cuff region. In addition, the results showed that longer intubation was also associated with increased tracheostomy rate from 9.3% to 28.9% for Group I and Group II respectively (P = 0.025). We conclude that longer intubation has a higher pathogen colonization rate over the ETT cuff region in patients receiving mechanical ventilation support; longer intubation also increases the trend of receiving re-intubation and tracheostomy. Our findings indicate that it is crucial to remove ETT as soon as possible and perform pathogen culture over the ETT cuff regions immediately after extubation.

Original languageEnglish
Pages (from-to)152-157
Number of pages6
JournalChinese Journal of Physiology
Volume57
Issue number3
DOIs
Publication statusPublished - 2014

Fingerprint

Intubation
Tracheostomy
Artificial Respiration
Ventilator-Associated Pneumonia
Intratracheal Intubation
Mechanical Ventilators
Sputum
Morbidity
Mortality

Keywords

  • Endotracheal tube cuff
  • Re-intubation
  • Tracheostomy
  • Ventilator-associated pneumonia

ASJC Scopus subject areas

  • Physiology
  • Physiology (medical)
  • Medicine(all)

Cite this

Increased risks of endotracheal tube cuff colonization after prolonged intubation. / Tsai, Wen Hui; Hsu, Hui Chi; Shih, Chung Hung.

In: Chinese Journal of Physiology, Vol. 57, No. 3, 2014, p. 152-157.

Research output: Contribution to journalArticle

@article{0f0e1359908245029c5823901494d159,
title = "Increased risks of endotracheal tube cuff colonization after prolonged intubation",
abstract = "Mechanical ventilation using endotracheal tube (ETT) intubation is crucial in saving life but may also cause ventilator-associated pneumonia resulting in morbidity and mortality. The purpose of this study was to examine the effects of intubation duration on pathogen colonization rates of ETT cuff region, and its association with the subsequent re-intubation and tracheostomy. We enrolled 92 patients who were successfully weaned from ventilator and were extubated within 20 days of intubation duration. Patients were divided into Group I and II based on intubation for 1-9 days and 10-20 days, respectively. Pathogen colonization over ETT cuff region and extra-cuff region (including sputum and ETT aspirates) were assessed. As compared to Group I patients, Group II patients had a significant higher pathogen colonization rate (100{\%} vs. 69.2{\%}; P <0.001) in the ETT cuff samples, but not in the extracuff samples (92.6{\%} vs. 84.8{\%}; P = 0.442). Further studies demonstrated that there was no difference between Group I and II patients in the percentages of patients with the same pathogen over both the cuff and extra-cuff samples (35.5{\%} vs. 30.8{\%}; P = 0.925), suggesting that the increased pathogen colonization rate over the ETT cuff region was least likely from the extra-cuff region. In addition, the results showed that longer intubation was also associated with increased tracheostomy rate from 9.3{\%} to 28.9{\%} for Group I and Group II respectively (P = 0.025). We conclude that longer intubation has a higher pathogen colonization rate over the ETT cuff region in patients receiving mechanical ventilation support; longer intubation also increases the trend of receiving re-intubation and tracheostomy. Our findings indicate that it is crucial to remove ETT as soon as possible and perform pathogen culture over the ETT cuff regions immediately after extubation.",
keywords = "Endotracheal tube cuff, Re-intubation, Tracheostomy, Ventilator-associated pneumonia",
author = "Tsai, {Wen Hui} and Hsu, {Hui Chi} and Shih, {Chung Hung}",
year = "2014",
doi = "10.4077/CJP.2014.BAC217",
language = "English",
volume = "57",
pages = "152--157",
journal = "Chinese Journal of Physiology",
issn = "0304-4920",
publisher = "Chinese Physiological Society",
number = "3",

}

TY - JOUR

T1 - Increased risks of endotracheal tube cuff colonization after prolonged intubation

AU - Tsai, Wen Hui

AU - Hsu, Hui Chi

AU - Shih, Chung Hung

PY - 2014

Y1 - 2014

N2 - Mechanical ventilation using endotracheal tube (ETT) intubation is crucial in saving life but may also cause ventilator-associated pneumonia resulting in morbidity and mortality. The purpose of this study was to examine the effects of intubation duration on pathogen colonization rates of ETT cuff region, and its association with the subsequent re-intubation and tracheostomy. We enrolled 92 patients who were successfully weaned from ventilator and were extubated within 20 days of intubation duration. Patients were divided into Group I and II based on intubation for 1-9 days and 10-20 days, respectively. Pathogen colonization over ETT cuff region and extra-cuff region (including sputum and ETT aspirates) were assessed. As compared to Group I patients, Group II patients had a significant higher pathogen colonization rate (100% vs. 69.2%; P <0.001) in the ETT cuff samples, but not in the extracuff samples (92.6% vs. 84.8%; P = 0.442). Further studies demonstrated that there was no difference between Group I and II patients in the percentages of patients with the same pathogen over both the cuff and extra-cuff samples (35.5% vs. 30.8%; P = 0.925), suggesting that the increased pathogen colonization rate over the ETT cuff region was least likely from the extra-cuff region. In addition, the results showed that longer intubation was also associated with increased tracheostomy rate from 9.3% to 28.9% for Group I and Group II respectively (P = 0.025). We conclude that longer intubation has a higher pathogen colonization rate over the ETT cuff region in patients receiving mechanical ventilation support; longer intubation also increases the trend of receiving re-intubation and tracheostomy. Our findings indicate that it is crucial to remove ETT as soon as possible and perform pathogen culture over the ETT cuff regions immediately after extubation.

AB - Mechanical ventilation using endotracheal tube (ETT) intubation is crucial in saving life but may also cause ventilator-associated pneumonia resulting in morbidity and mortality. The purpose of this study was to examine the effects of intubation duration on pathogen colonization rates of ETT cuff region, and its association with the subsequent re-intubation and tracheostomy. We enrolled 92 patients who were successfully weaned from ventilator and were extubated within 20 days of intubation duration. Patients were divided into Group I and II based on intubation for 1-9 days and 10-20 days, respectively. Pathogen colonization over ETT cuff region and extra-cuff region (including sputum and ETT aspirates) were assessed. As compared to Group I patients, Group II patients had a significant higher pathogen colonization rate (100% vs. 69.2%; P <0.001) in the ETT cuff samples, but not in the extracuff samples (92.6% vs. 84.8%; P = 0.442). Further studies demonstrated that there was no difference between Group I and II patients in the percentages of patients with the same pathogen over both the cuff and extra-cuff samples (35.5% vs. 30.8%; P = 0.925), suggesting that the increased pathogen colonization rate over the ETT cuff region was least likely from the extra-cuff region. In addition, the results showed that longer intubation was also associated with increased tracheostomy rate from 9.3% to 28.9% for Group I and Group II respectively (P = 0.025). We conclude that longer intubation has a higher pathogen colonization rate over the ETT cuff region in patients receiving mechanical ventilation support; longer intubation also increases the trend of receiving re-intubation and tracheostomy. Our findings indicate that it is crucial to remove ETT as soon as possible and perform pathogen culture over the ETT cuff regions immediately after extubation.

KW - Endotracheal tube cuff

KW - Re-intubation

KW - Tracheostomy

KW - Ventilator-associated pneumonia

UR - http://www.scopus.com/inward/record.url?scp=84903304091&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84903304091&partnerID=8YFLogxK

U2 - 10.4077/CJP.2014.BAC217

DO - 10.4077/CJP.2014.BAC217

M3 - Article

C2 - 24826783

AN - SCOPUS:84903304091

VL - 57

SP - 152

EP - 157

JO - Chinese Journal of Physiology

JF - Chinese Journal of Physiology

SN - 0304-4920

IS - 3

ER -