Biofilms and Ventilation
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The need for mechanical ventilation (MV) has paralleled the growth of the ICU for a ageing population with multiple disease entities, particularly those associated with pulmonary diseases. As the process of ventilation has improved, the etiology of Ventilator-Associated Pneumonia (VAP) has moved from the instrumentation to the colonization of the patient, focusing most recently on the link of normal oral flora as the initial, catalyzing insult in patients at risk for pneumonia through a biofilm in the lumen of the endotrachial tube (ETT).
The ETT, particularly the lumen, is an unrecognised reservoir for biofilms in the evolving discussion of indwelling medical device (IMD)-associated infections; yet it is the perfect environment for such communities to form. The endotrach lumen is protected from systemic therapeutic interventions. The environment is rich with the parameters associated with biofilm development.
Risk factors for ventilator-associated pneumonia and development of ETT luminal biofilms are multi-factorial including: length of hospitalization, surgery, prior antibiotic usage, stress ulcer prophylaxis, host factors such as ARDS, upper aspiratory colonization, and poor oral hygiene. The most significant risk factors, however, appear to be length of mechanical ventilation and prior exposure to antibiotic therapy.
KeywordsQuorum Sensing Respir Crit Multiple Organ Dysfunction Syndrome Nosocomial Pneumonia Infectious Disease Society
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