Method:
Extubated ETT secretions from forty patients were removed by the device – lung-to-oral-end within 8 sec.
Cleaned ETTs were sectioned into: A (oral), B (middle), and C (lung) and placed in 10% buffered formalin. Structures were highlighted by spatter coating with gold palladium using a Hitachi S-4700 electron microscope with an EDAX brand EDS Detector.
Sections were graded utilizing coded photomicrographs according to type and quantity of non biological material (A-C) or biologic material (D) at five magnifications (1000, 100, 50, 20, 10, 2 μm) and staged (I-IV), utilizing a six-criterion template. 36 clinical parameters were collected.
Result:
We evaluated 661 micrographs representing 3 ETT sections.
Architecture could be grouped into four categories (A-D) with most demonstrating Biofilm Configuration (D). Similar to plaque controls and uninterrupted ETT biofilm development, structural microbial morphologies highlighted grape-like clusters (64%) consistent with Stretococci sp, hyphal and yeast-like structures consistent with Candida sp. (87%) and, various gram negative rods (34%) associated with oral microbiota.
Significant differences were noted in ETT Sections A, B, and C with Section A yielding the Stages I & II, while sections B & C yielded the most biofilm (Stage III), sometimes showing Stage IV.
Residual architecture and ETT composition could not be correlated with length of stay (LOS), length of intubation, co-morbidities, or physical parameters of MV but could be correlated with pneumonia and biofilm stage III
Conclusion:
SEM analysis of a residual ETT material defined a plaque like biofilm 3-D architecture associated with oral plaque; this highlighted known adherence of dental microbes, recognizing oral care to reduce pneumonia for ventilated patients.