Ventilator-Associated Pneumonia. Mucus Slurper. Mucucili

1.“粘液刮刀”和“粘液Slurper” 我们之前已经开发了一种方法，通过使用导管安装的特殊可膨胀球囊，连接两个或更多个“剃须环”，完全清洁插管绵羊的气管插管内腔。在一次清扫中，气管插管的整个长度都没有粘液（粘液刮除器）。 我们现在已经改进了市售气管导管（卡斯气管导管，Mallinckrodt Inc.），允许通过气管内导管最远端的多个端口自发、自动、定时地抽吸粘液，持续几毫秒-在此过程中，当粘液/分泌物到达这种改良的气管导管的尖端时，将其去除（Mucus Slurper）。该过程是自动的，定时为在呼气阶段开始后几毫秒激活。这使气管内导管不含粘液和分泌物，并且不需要定期手动（并且从未完全有效）气管/气管导管抽吸。 2.粘液纤毛转运 根据我们早期的研究，我们已经表明，上述水平方向（30 °）是决定实验动物（绵羊）是否发生呼吸机相关性肺炎（VAP）的单一变量，（这是目前对使用机械呼吸机的病人的常规做法）;而在绵羊的实验室研究中，当气管导管/气管处于或低于水平方向时，粘液通过气管导管自发排出，而没有发生VAP。 在目前正在进行的绵羊研究中，我们已经证明，小的1 mm钽盘（也适用于细菌定殖的粘液），吹入绵羊的气管中部，气管/气管导管的方向刚好低于水平，自发地向外朝向嘴移动;当钽盘吹入气管/气管导管时，并且头/躯干处于现在临床上优选的半卧位（均高于水平30度），沿逆行方向朝向肺移动。后一过程与VAP的非常高/一定概率相关。 因此，我们的结论是，VAP在插管患者是一种可以避免的疾病，提供了这些新发现的经验教训，充分应用。

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.