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The first part of the inner wall of the endotracheal tube mechanical ventilation in children with bacterial biofilm formation and pathogen Objective: To observe the PICU (Pediatric intensive care unit, PICU) mechanical ventilation (mechanical ventilation, MV) children endotracheal tube (endotracheal tube, ETT) wall bacterial biofilms (biofilm, BF) BF bacteria distribution and morphological characteristics Methods: 35 cases treated in our hospital MV patients for the study. Collect first unplugging ETT, after propidium iodide (PI) and fluorescein isothiocyanate-labeled concanavalin A (FITCConA) staining, laser scanning confocal microscope (Confocal Laser Canning Microscopy, CLSM) observation ETT-BF bacteria and extracellular polysaccharides (extracellular polymeric substances, EPS) distribution and ETT and lower respiratory tract secretions collected bacteria were isolated, cultured and identified. Results: (1) 35 cases of MV in children, ETT surface culture positive 31 cases (88.57%); 17 cases ETT surface and lower respiratory tract secretions while the same species isolated, accounting for 54.83% culture-positive ETT. In the ETT-BF and lower respiratory tract secretions Staphylococcus aureus, Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae the most common. (2) CLSM observation shows, endotracheal intubation after 12h, ETT surface by bacterial adhesion; 48h ETT visible on the surface when a large number of short rod or spherical bacterial adhesion and aggregation, EPS was significantly increased when compared to 12h, the initial formation of BF structure; 72h around bacterial adhesion into lumps were wrapped in EPS, showing mature BF structure formation; 7 days after bacterial adhesion NCKU flakes, scattered in the surrounding micro-colonies. (3) 35 cases of MV children, 19 cases occurred in ventilator-associated pneumonia (Ventilated-associated Pneumonia, VAP), in which oral intubation 10 cases (62.5%), nasal cannula 9 cases (100%) , but the difference was not statistically significant (P gt; 0.05). Conclusion: MV is easily in the ETT surface adhesion of bacteria, forming bacteria BF. ETT and BF wall formation and bacterial colonization in children associated with prolonged MV ventilator-associated pneumonia may exist between certain correlation. The second part of the balloon catheter intervention mechanical cleaning method endotracheal tube wall clinical study bacterial biofilm formation Objective: To investigate balloon catheter mechanical cleaning method of mechanical ventilation (mechanical ventilation, MV) children endotracheal tube (endotracheal tube, ETT) wall bacterial biofilms (biofilm, BF) formation in rats. METHODS: A prospective, randomized, controlled design, the MV 90 cases of children with congenital heart disease by surgery with cardiopulmonary bypass (CPB) and pneumococcal disease were randomly divided into two mechanical cleaning balloon catheter group (daily three times for group A, group B 2 times a day) and control group (C group). Plate count method ETT-BF bacterial colonies; PI / FITC-ConA staining, CLSM observation ETT-BF structures and biofilm thickness variation; compared three groups ETT and lower respiratory tract secretions changes in bacterial species and ICU admission time, MV time, ventilator-associated pneumonia (Ventilator-associated Pneumonia, VAP) were observed. Results: (1) colony counts: ① CPB groups: A ETT-BF bacterial colony counts significantly reduced compared with C group (P lt; 0.05), B and C group ETT-BF bacterial colony counts in MV0-2d when the difference was not significant, but with prolonged MV, the colony count difference was statistically significant (P lt; 0.05); ② pneumonia group: A, B group ETT-BF bacterial colony counts significantly reduced compared with C group (P lt; 0.05). (2) bacterial culture positive rate: ① CPB group and the pneumonia group A, B group of lower respiratory tract secretions culture positive rate was significantly lower than the C group, the difference was statistically significant (P lt; 0.05), the heads of bacterial respiratory secretions normal flora species mainly dominated; ② pump group and pneumonia group A, B group ETT culture positive rate lower than the C group, but the difference was not statistically significant (P gt; 0.05). (3) CLSM observation, C group showed green fluorescence of the red cloudy bacterial EPS wrapped with a certain thickness to form mature BF, A group, only scattered dyed red see bacteria, no BF form; B group A group of more than the number of bacteria, showing a small amount of green fluorescence. BF thickness: CPB group C 1d, 3d, 7d Asian group were 26.73 ± 3.52μm, 37.43 ± 4.86μm, 43.51 ± 2.30μm, BF thickness increases with the increase of MV time, the difference was statistically significant (P lt ; 0.05); A, B group BF thickness compared with C group were significantly thinner (P lt; 0.05), the effect is more obvious in group A, and between group A and group B BF thickness was no significant difference (P gt; 0.05). Pneumonia group after mechanical cleaning by balloon catheter A, B group BF thickness were significantly thinner (P lt; 0.05) trend with CPB. (4) pump group and pneumonia groups A, B and C group, the incidence of VAP group difference was statistically significant, three groups of patients admitted to the ICU time, MV time difference was not significant, but the A, B group ICU stay, MV time a decreasing trend, A group of more obvious. Conclusion: balloon catheter mechanical cleaning method can effectively remove the endotracheal tube secretions, delay and prevent the formation of ETT-BF, reduce the incidence of VAP, in order to effect more pronounced three times a day, can be safely used in clinical nursing practice.
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