Title :

Transesophageal echocardiography-associated tracheal microaspiration and ventilator-associated pneumonia in intubated critically ill patients: a multicenter prospective observational study

Author(s) :

Bagate, François [Auteur]
CHU Henri Mondor [Créteil]
Rouze, Anahita [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Unité de Glycobiologie Structurale et Fonctionnelle (UGSF) - UMR 8576
Zerimech, Farid [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
IMPact de l'Environnement Chimique sur la Santé humaine (IMPECS) - ULR 4483
Boissier, Florence [Auteur]
Centre hospitalier universitaire de Poitiers = Poitiers University Hospital [CHU de Poitiers [La Milétrie]]
Labbe, Vincent [Auteur]
CHU Tenon [AP-HP]
Razazi, Keyvan [Auteur]
CHU Henri Mondor [Créteil]
Carteaux, Guillaume [Auteur]
CHU Henri Mondor [Créteil]
de Prost, Nicolas [Auteur]
CHU Henri Mondor [Créteil]
Balduyck, Malika [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Maladies Rares du Développement : Génétique, Régulation et Protéomique (RADEME) - ULR 7364
Maladies RAres du DÉveloppement embryonnaire et du Métabolisme : du phénotype au génotype et à la Fonction (RADEME) - ULR 7364
Maboudou, Patrice [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Nseir, Saad [Auteur]
Unité de Glycobiologie Structurale et Fonctionnelle (UGSF) - UMR 8576
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Mekontso Dessap, Armand [Auteur]
CHU Henri Mondor [Créteil]

Journal title :

Critical Care

Abbreviated title :

Crit Care

Volume number :

24

Publisher :

Springer Science and Business Media LLC

Publication date :

2020-12

ISSN :

1364-8535

English keyword(s) :

Microaspiration
Transesophageal echocardiography
Pepsin
Salivary amylase

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Background Microaspiration of gastric and oropharyngeal secretions is the main causative mechanism of ventilator-associated pneumonia (VAP). Transesophageal echocardiography (TEE) is a routine investigation tool in intensive ...
Show more >Background Microaspiration of gastric and oropharyngeal secretions is the main causative mechanism of ventilator-associated pneumonia (VAP). Transesophageal echocardiography (TEE) is a routine investigation tool in intensive care unit and could enhance microaspiration. This study aimed at evaluating the impact of TEE on microaspiration and VAP in intubated critically ill adult patients. Methods It is a four-center prospective observational study. Microaspiration biomarkers (pepsin and salivary amylase) concentrations were quantitatively measured on tracheal aspirates drawn before and after TEE. The primary endpoint was the percentage of patients with TEE-associated microaspiration, defined as: (1) ≥ 50% increase in biomarker concentration between pre-TEE and post-TEE samples, and (2) a significant post-TEE biomarker concentration (> 200 μg/L for pepsin and/or > 1685 IU/L for salivary amylase). Secondary endpoints included the development of VAP within three days after TEE and the evolution of tracheal cuff pressure throughout TEE. Results We enrolled 100 patients (35 females), with a median age of 64 (53–72) years. Of the 74 patients analyzed for biomarkers, 17 (23%) got TEE-associated microaspiration. However, overall, pepsin and salivary amylase levels were not significantly different between before and after TEE, with wide interindividual variability. VAP occurred in 19 patients (19%) within 3 days following TEE. VAP patients had a larger tracheal tube size and endured more attempts of TEE probe introduction than their counterparts but showed similar aspiration biomarker concentrations. TEE induced an increase in tracheal cuff pressure, especially during insertion and removal of the probe. Conclusions We could not find any association between TEE-associated microaspiration and the development of VAP during the three days following TEE in intubated critically ill patients. However, our study cannot formally rule out a role for TEE because of the high rate of VAP observed after TEE and the limitations of our methods.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

Université de Lille
CNRS

Collections :

• IMPact de l'Environnement Chimique sur la Santé humaine (IMPECS) - ULR 4483
• Maladies Rares du Développement : Génétique, Régulation et Protéomique (RADEME) - ULR 7364
• Unité de Glycobiologie Structurale et Fonctionnelle (UGSF) - UMR 8576

Research team(s) :

Glycobiology in fungal Pathogenesis and Clinical Applications

Submission date :

2021-07-15T09:15:12Z
2021-08-25T07:11:05Z