Related Experiment Videos
Gastroduodenal dysfunction and bacterial colonisation of the ventilated lung
T J Inglis1, M J Sherratt, L J Sproat
1Department of Microbiology, University of Leeds.
Lancet (London, England)
|April 10, 1993
Summary
The stomach, not the throat, is the source of ventilator-associated pneumonia in intensive care patients. Duodenal reflux and gastric bacterial overgrowth are linked to lung infections, suggesting motility restoration could prevent pneumonia.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Gastroenterology
Background:
- Ventilator-associated pneumonia (VAP) is a common intensive care unit (ICU) complication.
- The primary source of bacterial colonization in the ventilated lung (gastric or oropharyngeal flora) remains debated.
Purpose of the Study:
- To investigate the source of bacterial colonization leading to VAP in ICU patients.
- To determine the relationship between gastric/duodenal contents and lower respiratory tract infections.
Main Methods:
- Prospective investigation of 100 consecutive ICU patients on mechanical ventilation.
- Bacterial cultures of lower respiratory tract, gastric aspirates, and oropharyngeal swabs.
- Analysis of gastric contents for pH and bilirubin presence.
Main Results:
- Gram-negative bacilli were isolated from the lower respiratory tract in 19 patients.
- Gastric isolates matched lower respiratory tract isolates in 11 patients; no oropharyngeal isolates matched.
- Gastric bacterial overgrowth, presence of bilirubin, and subsequent lower respiratory tract colonization were associated.
Conclusions:
- The stomach, specifically via duodenal reflux, is a significant source of bacterial colonization in the ventilated lung.
- Gastric bacterial overgrowth, indicated by bilirubin presence and elevated pH, precedes VAP.
- Restoring normal gastroduodenal motility may be a strategy to prevent VAP in critically ill patients.