MUCOCILIARY TRANSPORT IN ICU PATIENTS

Objectives: The objectives of this study were to determine the bronchi al mucus transport velocities in ventilated ICU patients and to study the possible role of impaired mucus transport in the development of re tention of secretion and pneumonia. Design: The patients were studied prospectively in a convenience sample trial. Setting: The study took p lace at a university hospital. Patients: Thirty-two ventilated patient s in a surgical ICU were included in the study. The study was approved by the Ethics Committee of the University of Ulm. Interventions: Bron chial mucus transport velocity (BTV) was measured with a small volume of technetium 99m-labeled albumin microspheres within the first 3 days of mechanical ventilation. The radiolabeled bolus was deposited at th e distal end of the light and left main bronchus via flexible bronchos copy. The movement of the microspheres toward the trachea was visualiz ed and recorded using a scintillation camera. After determination of B TV, the patients were examined daily for 4 days to record pulmonary co mplications (defined as retention of secretion and nosocomial pneumoni a). Main measurements and results: The median BTV in the right primary bronchus was 0.8 mm/min and in the left it was 1.4 mm/min. In nine pa tients both radioactive drops remained at the application site. In 14 patients, a total of 19 pulmonary complications occurred (10 times ret ention of secretion, 9 times pneumonia). Patients with pulmonary compl ications had statistically significant lower BTV compared with patient s without pulmonary complications; in the left bronchus 0 (0 to 6.5) m m/ min (median with range) vs 3.5 (0 to 10.5) mm/min (p < 0.01) and in the right bronchus 0 (0 to 3.0) mm/min vs 4.7 (0 to 11.7) mm/min (p < 0.01). Conclusions: Ventilated patients in the ICU frequently have im paired mucus transport, which is associated with the development of re tention of secretion and pneumonia.