Detecting the efficacy of endotracheal tube suctioning in intubated ICU patients using in vivo catheter-based OCT (Conference Presentation)

Abstract

Mechanical ventilation is a critical intervention given to intensive care unit (ICU) patients who need airway support. However, this intervention with an endotracheal tube (ETT) is associated with complications such as ventilator-associated pneumonia (VAP). VAP is reported to develop within 48 hours after intubation and is associated with a mortality rate between 20 to 50%. The formation of bacterial biofilms within these ETT tubes provides a niche for infectious bacteria to become resistant to antibiotics. Suctioning of the ETT is believed to prevent airway colonization by pathogens, reduce resistance to airflow, and decrease biofilm formation. However, reports have shown that standard-of-care suctioning is not adequate to eliminate secretions from the ETT, and additional measures aiming to reduce the formation of ETT biofilms have been proposed to reduce VAP. We have recently demonstrated the use of catheter-based 3-D OCT imaging to identify the presence of in vivo biofilms within the ETTs of intubated human subjects in the ICU. In this study, we quantify the volume of mucus and biofilm in ETTs in intubated ICU patients using 3-D OCT, and define the efficacy of suctioning. Longitudinal OCT imaging was performed daily before and after suctioning at approximately 24-hour intervals until extubation. Extubated ETTs were subsequently imaged for further analysis. OCT image analysis results were correlated with clinical data and fluorescence microscopy/Gram stain images to verify the presence of bacteria and biofilm. In vivo catheter-based 3-D OCT offers the potential to rapidly determine the efficacy of ETT suctioning in order to effectively compare suctioning and brushing strategies in an effort to reduce the incidence of VAP.