Chest
Volume 105, Issue 1, January 1994, Pages 237-241
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Clinical Investigations in Critical Care
Mucociliary Transport in ICU Patients

https://doi.org/10.1378/chest.105.1.237Get rights and content

Objectives

The objectives of this study were to determine the bronchial mucus transport velocities in ventilated ICU patients and to study the possible role of impaired mucus transport in the development of retention of secretion and pneumonia.

Design

The patients were studied prospectively in a convenience sample trial.

Setting

The study took place at a university hospital.

Patients

Thirty-two ventilated patients in a surgical ICU were included in the study. The study was approved by the Ethics Committee of the University of Ulm.

Interventions

Bronchial 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 the distal end of the right and left main bronchus via flexible bronchoscopy. The movement of the microspheres toward the trachea was visualized and recorded using a scintillation camera. After determination of BTV, the patients were examined daily for 4 days to record pulmonary complications (defined as retention of secretion and nosocomial pneumonia).

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 patients both radioactive drops remained at the application site. In 14 patients, a total of 19 pulmonary complications occurred (10 times retention of secretion, 9 times pneumonia). Patients with pulmonary complications had statistically significant lower BTV compared with patients without pulmonary complications; in the left bronchus 0 (0 to 6.5) mm/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 impaired mucus transport, which is associated with the development of retention of secretion and pneumonia.

Section snippets

Determination of BTV

To measure BTV, we used a method based on that of Chopra et al8 who had determined the motion of a radioactive bolus in the trachea. The measurement of transport velocity in the trachea of intubated patients presents a problem, since the distance from the distal end of the trachea to the tip of the tube and thus the measuring distance can in some cases be very short.9 For this reason, we decided to measure the transport velocity in the right and left primary bronchus. The measurements were

Bronchial Transport Velocities

Table 1 provides information about diagnoses or operations, respectively. Demographic data, medication, duration of mechanical ventilation (MV) up to the time of measurement, APACHE II score,17 and BTV are listed in Table 2. The median BTV in the right primary bronchus was 0.8 mm/min and in the left it was 1.4 mm/min. In 9 of 32 patients studied, both radioactive drops remained at the application site. In these patients, a further measurement was performed 1 h later. Once again, no transport

Discussion

In man, the average tracheal transport velocity using bronchofiberscopic methods is reported to be about 10 mm/min.18 We determined the transport velocity in both primary bronchi, not in the trachea, in order to avoid methodical errors, specifically related to intubated patients. Depending on the anatomic conditions, the distance from the distal end of the trachea to the tip of the tube, and thus the measuring distance, can be very short.9 In addition, mucus transport presumably ends at the

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