Infection control
VAP is a common menace within ICUs, affecting around 20% of critically ill patients who have been mechanically ventilated for 48 hours.
University of Warwick. “You’ll have a subset of people who were young, healthy adults, who had an accident and ended up being ventilated, but most people will have an underlying immune issue or infection. So they might have Covid-19, they might have COPD, they might have conditions like diabetes that reduce their ability to fight infection.” The upshot is that VAP can be hard to eradicate. Although antibiotic treatment does sometimes clear the infection, VAP recurrences are common, and the bacterial biofilms often persist on the ventilator tubes. Factor in any underlying health conditions or immune disturbances, and it’s easy to see why patients remain so vulnerable. “With any indwelling medical device, you’re providing a surface for infection,” says Harrison. “Add in the fact that, if you’re on a ventilator, you’ll be sedated, you’ll be lying down, so your cough reflex is gone. You can’t clear your secretions. So you have this horrible situation where all of your oropharyngeal secretions will pool around this tube in your throat.”
Possible solutions have been suggested. For instance, patients will be laid prone on their front – a more desirable angle for clearing secretions – or the healthcare team may try to physically clear those secretions using a suction tube. There are also tubes on the market with antimicrobial coatings, which have performed fairly well in clinical trials. However, none of these options represent a silver bullet. The suction tube can come with added risk to the patient, while the coated tubes are not very cost-effective considering the scope of their benefits. “It’s really interesting to compare this with something like wound care, where you have all of these advanced dressings with additions that try to prevent bacterial or fungal colonisation,” notes Harrison. “We’re not
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there yet with these tubes – they don’t have a great impact on reducing colonisation.”
Fighting for air
The research community is intent on finding better answers. One possible option, pioneered by Viromed Medical in Germany, is cold plasma therapy, which has already proved successful in treating hard-to-heal wounds. Cold plasma holds great promise compared to traditional antimicrobial treatments: it can reach the site of infection within a few minutes, where it destroys pathogens physically, even those that have grown resistant to antibiotics.
“If the positive preliminary results of our study are confirmed, cold plasma could revolutionise the treatment of ventilated patients,” said Professor Hortense Sleveogt of the Hanover Medical School, who is leading the project’s scientific direction. Another possible strategy might be to administer probiotics. If given to all mechanically ventilated patients, they might help reduce the incidence of VAP, while slashing antibiotic usage. Amid some rather mixed results, some studies have suggested there might be a significant benefit. Researchers are also working on monoclonal antibodies and vaccines for VAP. While this work remains at an early stage of development, these kinds of treatments could be a gamechanger within a post-antibiotic era. Other teams, meanwhile, are exploring rapid sensitivity testing, which will improve diagnosis and enable patients to be treated with better targeted antibiotics. Harrison’s team at the University of Warwick are less interested in finding new treatment strategies, and more in improving the basic state of research in the field. In August 2024, they published a paper in the journal Microbiology, detailing a recent breakthrough. By creating an accurate model of hospital conditions,
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