Ventilator-Associated Pneumonia (VAP) is a well-known complication of ventilatory support for the intubated patient, and one of the greatest clinical challenges facing intensivists today. Mortality rate for patients with VAP has been reported to be as high as 70% in some studies. In 1991, the annual cost of diagnosing and treating VAP was estimated to exceed $2 billion.
There are several mechanisms by which a bacterial nidus can cause or perpetuate VAP. One of the most significant may be the bacterial biofilm that is usually established within the endotracheal tube and becomes mixed with the patient's own mucus and secretions. This inconspicuous source for ongoing VAP and pneumonitis has been studied using electron microscopy and by genotyping, and a significant correlation has been established by the pathogens identified within the endotracheal tube and those that cause VAP. Numerous studies have also shown how aggregates of bacteria present within the lumen of the endotracheal tube can easily be propelled by a ventilator breath, by saline lavage of the endotracheal tube, or through mechanical disruption (i.e. by a suction catheter) from the endotracheal tube and into the patient's distal airways. As appreciation for endotracheal tube biofilm and its impact on intubated patients grows within the clinical community, several investigators have proposed that 'Endotracheal Tube-Associated Pneumonia' would be a more appropriate designation for this disease process.
With increasing awareness of the key role that biofilms play in disease processes, new approaches have been studied in an effort to reduce the significant effects of the bioburden imposed by these. One strategy has been to manipulate the routes and delivery modes of various antibiotics. However, there are serious drawbacks to the use of antibiotics prophylactically and therapeutically if they are used for extended periods of time. There is a need for non-antibiotic strategies to help prevent and manage VAP in the intubated patient.
Bacterial bioburden can be reduced by effectively removing infective secretions and bacterial biofilm from the lumen of the endotracheal tube. It is a critical non-antibiotic component of a multifaceted approach to the management of patients at risk for VAP. Use of CAM Rescue Cath™ could reduce the need for invasive procedures, excessive suctioning and saline lavage of the endotracheal tube, all of which have been associated with adverse effects to the patient. Preventing reintubations due to endotracheal tube obstructions can also reduce the risk of VAP associated with unplanned extubation and reintubation.
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