Transesophageal echocardiography-associated tracheal microaspiration and ventilator-associated pneumonia in intubated cr
- PDF / 1,595,816 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 9 Downloads / 162 Views
Open Access
RESEARCH
Transesophageal echocardiography‑associated tracheal microaspiration and ventilator‑associated pneumonia in intubated critically ill patients: a multicenter prospective observational study François Bagate1,2 , Anahita Rouzé3, Farid Zerimech4, Florence Boissier5,6, Vincent Labbe2,7, Keyvan Razazi1,2, Guillaume Carteaux1,2, Nicolas de Prost1,2, Malika Balduyck4,8, Patrice Maboudou4, Saad Nseir3,9 and Armand Mekontso Dessap1,2,10*
Abstract Background: Microaspiration of gastric and oropharyngeal secretions is the main causative mechanism of ventilatorassociated pneumonia (VAP). Transesophageal echocardiography (TEE) is a routine investigation tool in intensive care unit and could enhance microaspiration. This study aimed at evaluating the impact of TEE on microaspiration and VAP in intubated critically ill adult patients. Methods: It is a four-center prospective observational study. Microaspiration biomarkers (pepsin and salivary amylase) concentrations were quantitatively measured on tracheal aspirates drawn before and after TEE. The primary endpoint was the percentage of patients with TEE-associated microaspiration, defined as: (1) ≥ 50% increase in biomarker concentration between pre-TEE and post-TEE samples, and (2) a significant post-TEE biomarker concentration (> 200 μg/L for pepsin and/or > 1685 IU/L for salivary amylase). Secondary endpoints included the development of VAP within three days after TEE and the evolution of tracheal cuff pressure throughout TEE. Results: We enrolled 100 patients (35 females), with a median age of 64 (53–72) years. Of the 74 patients analyzed for biomarkers, 17 (23%) got TEE-associated microaspiration. However, overall, pepsin and salivary amylase levels were not significantly different between before and after TEE, with wide interindividual variability. VAP occurred in 19 patients (19%) within 3 days following TEE. VAP patients had a larger tracheal tube size and endured more attempts of TEE probe introduction than their counterparts but showed similar aspiration biomarker concentrations. TEE induced an increase in tracheal cuff pressure, especially during insertion and removal of the probe. Conclusions: We could not find any association between TEE-associated microaspiration and the development of VAP during the three days following TEE in intubated critically ill patients. However, our study cannot formally rule out a role for TEE because of the high rate of VAP observed after TEE and the limitations of our methods.
*Correspondence: [email protected] 1 DHU A‑TVB, Service de Médecine Intensive Réanimation, AP-HP, CHU Henri Mondor, 51, avenue du Mal de Lattre de Tassigny, 94010 Créteil, France Full list of author information is available at the end of the article © The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and th
Data Loading...
