Ventilator-Associated Pneumonia. Bactericidal Tracheal T

呼吸机相关肺炎。

• 批准号: 6809649
• 负责人: THEODOR KOLOBOW
• 金额: --
• 依托单位: NATIONAL HEART, LUNG, AND BLOOD INSTITUTE
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/6809649
• 关键词: biomedical equipment development; bronchial mucus; clinical biomedical equipment; intubation; nosocomial infection control; nosocomial infections; pneumonia; respirators; respiratory therapy; sheep; trachea

l. We explored whether, and under what conditions, mechanical pulmonary ventilation can lead to ventilator-induced lung injury (VILI) at airway pressures now considered safe, i.e., airway plateau pressure of 25 cm H20. As in our previous studies (at a peak airway plateau pressure of 50 cm H20, an end inspiratory time of 2.5 s), we now show that such mechanial ventilation at a "safe" peak inspiratory pressure of 25 cm H20, and (also) at an inspiatory time of 2.5 s, will result in major functional chanes within 2 h of mechanical ventilation, with further changes during subsequent 48 - 72 h of mechanical ventilation. 2. We further explored methods to fabricate tracheal tubes coated with bactericidal agents, dispersed/dissolved in polyurethane, and evaluated their bacericidal effectiveness in long-term studies in sheep. We evaluated silver sulfadiazine (SSD) in polyurethane, and chlorhxidine (CHD) in polyurethane; and silver-platinum-carbon in polyurethane. Those coatings are highly effecive, but decrease in efficacy if thick mucus is allowed to accumulate within the tracheal tube (as is now common with sate-of-the-art suction devices). 3. To alleviate accumulation of mucus within the tracheal tube (and exend the bactericidal effect), we developed a novel system based on a modified balloon that allows rapid, and virtually total removal of all accumulated tracheal secretions, in one full sweep. The system is far more rapid and effective than conventional tacheal tube suctioning. Most importantly, there is total cleaning in just one pass, with no visible residue. 4. In sheep, using tracheal tubes coated with SSD and CHD dispersed in polyurethane see (2), and cleaned by the new system (see 3), while keeping the orientation of the tracheal tube horizontal (see 2002 annual report), we have extended the duration of mechanical ventilation, without bacterial colonization of the trachea or lungs, to 6 d; and while maintaining the tracheal tube free of all secretions, without use of systemic or topical antibiotics.

L.我们探讨了在目前认为安全的气道压力下，机械肺通气是否以及在什么条件下会导致呼吸机诱导的肺损伤（VILI），即，气道平台压为25 cm H2O。正如我们之前的研究一样（在50 cm H2O的峰值气道平台压力下，2.5 s的吸气结束时间），我们现在表明，在25 cm H2O的“安全”峰值吸气压力下以及（也）在2.5 s的吸气时间下的这种机械通气将导致机械通气2 h内的主要功能变化，在随后的48 - 72小时机械通气期间进一步变化。 2.我们进一步探索了制造涂有杀菌剂、分散/溶解在聚氨酯中的气管插管的方法，并在绵羊的长期研究中评价了其杀菌有效性。我们评价了聚氨酯中的磺胺嘧啶银（SSD）、聚氨酯中的氯己定（CHD）和聚氨酯中的银-铂-碳。这些涂层是非常有效的，但是如果厚粘液被允许在气管导管内积聚（如现在对于最先进的抽吸装置是常见的），则效力降低。 3.为了减轻气管导管内粘液的积聚（并延长杀菌效果），我们开发了一种基于改良球囊的新型系统，该系统允许在一次完整扫描中快速且几乎完全去除所有积聚的气管分泌物。该系统远比传统的气管导管抽吸更快速和有效。最重要的是，只需一次通过即可完全清洁，没有可见的残留物。 4.在绵羊中，使用涂有分散在聚氨酯中的SSD和CHD的气管插管（见（2）），并用新系统（见3）清洁，同时保持气管插管的方向水平（见2002年年度报告），我们将机械通气的持续时间延长至6天，气管或肺部无细菌定植;同时保持气管导管没有任何分泌物，而不使用全身或局部抗生素。