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THE IMPORTANCE OF AIRWAY AND LUNG MICROBIOME IN THE CRITICALLY ILL
Microbiome
Pneumonia
Ventilator-associated pneumonia
Ventilator-associated tracheobronchitis
Author
Affilliation
St James Hospital. Multidisciplinary Intensive Care Research Organization. Department of Intensive Care Medicine. Dublin, Ireland / CIBERes. IDIBAPS. Hospital Clinic. Department of Respiratory Medicine. Barcelona, Spain / Trinity College. Dublin, Ireland.
University of Michigan. Department of Internal Medicine. Division of Pulmonary and Critical Care Medicine. Ann Arbor, MI, USA / University of Michigan. Department of Microbiology and Immunology. Ann Arbor, MI, USA / Michigan Center for Integrative Research in Critical Care. Ann Arbor, MI, USA.
Hospital Clinic of Barcelona. Institut Clinic del Tórax. Deparment of Pneumology. Barcelona, Spain / University of Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer. Barcelona, Spain / Ciber de Enfermedades Respiratorias. Barcelona, Spain.
Linköping University. Department of Infectious Diseases. Linköping, Sweden / Linköping University. Department of Clinical and Experimental Medicine. Linköping, Sweden.
The University of Queensland. Brisbane, Australia / University of Montpellier. Nimes University Hospital. Scientific Consultant. Nimes, France.
Fondazione Policlinico Universitario A. Gemelli IRCCS. Intensive Care and Emergency Medicine. Department of Anesthesiology. Rome, Italy / Università Cattolica del Sacro Cuore. Rome, Italy.
Fondazione Policlinico Universitario A. Gemelli IRCCS. Intensive Care and Emergency Medicine. Department of Anesthesiology. Rome, Italy / Università Cattolica del Sacro Cuore. Rome, Italy.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Université Libre de Bruxelles. Erasme University Hospital. Department of Intensive Care. Brussels, Belgium.
University of British Columbia. Vancouver, BC, Canada.
Jena University Hospital. Department of Anesthesiology and Intensive Care Medicine. Am Klinikum, Jena, Germany.
University of Toronto. St Michael's Hospital. The Li Ka Shing Knowledge Institute. The Keenan Research Centre for Biomedical Science. Toronto, Ontario, Canada.
Hospital Clinic of Barcelona. Institut Clinic del Tórax. Deparment of Pneumology. Barcelona, Spain / University of Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer. Barcelona, Spain / Ciber de Enfermedades Respiratorias. Barcelona, Spain.
Amsterdam University Medical Center. Infection and Immunity. Department of Respiratory Medicine. Amsterdam, The Netherlands.
University of Michigan. Department of Internal Medicine. Division of Pulmonary and Critical Care Medicine. Ann Arbor, MI, USA / University of Michigan. Department of Microbiology and Immunology. Ann Arbor, MI, USA / Michigan Center for Integrative Research in Critical Care. Ann Arbor, MI, USA.
Hospital Clinic of Barcelona. Institut Clinic del Tórax. Deparment of Pneumology. Barcelona, Spain / University of Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer. Barcelona, Spain / Ciber de Enfermedades Respiratorias. Barcelona, Spain.
Linköping University. Department of Infectious Diseases. Linköping, Sweden / Linköping University. Department of Clinical and Experimental Medicine. Linköping, Sweden.
The University of Queensland. Brisbane, Australia / University of Montpellier. Nimes University Hospital. Scientific Consultant. Nimes, France.
Fondazione Policlinico Universitario A. Gemelli IRCCS. Intensive Care and Emergency Medicine. Department of Anesthesiology. Rome, Italy / Università Cattolica del Sacro Cuore. Rome, Italy.
Fondazione Policlinico Universitario A. Gemelli IRCCS. Intensive Care and Emergency Medicine. Department of Anesthesiology. Rome, Italy / Università Cattolica del Sacro Cuore. Rome, Italy.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Université Libre de Bruxelles. Erasme University Hospital. Department of Intensive Care. Brussels, Belgium.
University of British Columbia. Vancouver, BC, Canada.
Jena University Hospital. Department of Anesthesiology and Intensive Care Medicine. Am Klinikum, Jena, Germany.
University of Toronto. St Michael's Hospital. The Li Ka Shing Knowledge Institute. The Keenan Research Centre for Biomedical Science. Toronto, Ontario, Canada.
Hospital Clinic of Barcelona. Institut Clinic del Tórax. Deparment of Pneumology. Barcelona, Spain / University of Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer. Barcelona, Spain / Ciber de Enfermedades Respiratorias. Barcelona, Spain.
Amsterdam University Medical Center. Infection and Immunity. Department of Respiratory Medicine. Amsterdam, The Netherlands.
Abstract
During critical illness, there are a multitude of forces such as antibiotic use, mechanical ventilation, diet changes and inflammatory responses that could bring the microbiome out of balance. This so-called dysbiosis of the microbiome seems to be involved in immunological responses and may influence outcomes even in individuals who are not as vulnerable as a critically ill ICU population. It is therefore probable that dysbiosis of the microbiome is a consequence of critical illness and may, subsequently, shape an inadequate response to these circumstances.Bronchoscopic studies have revealed that the carina represents the densest site of bacterial DNA along healthy airways, with a tapering density with further bifurcations. This likely reflects the influence of micro-aspiration as the primary route of microbial immigration in healthy adults. Though bacterial DNA density grows extremely sparse at smaller airways, bacterial signal is still consistently detectable in bronchoalveolar lavage fluid, likely reflecting the fact that lavage via a wedged bronchoscope samples an enormous surface area of small airways and alveoli. The dogma of lung sterility also violated numerous observations that long predated culture-independent microbiology.The body's resident microbial consortia (gut and/or respiratory microbiota) affect normal host inflammatory and immune response mechanisms. Disruptions in these host-pathogen interactions have been associated with infection and altered innate immunity.In this narrative review, we will focus on the rationale and current evidence for a pathogenic role of the lung microbiome in the exacerbation of complications of critical illness, such as acute respiratory distress syndrome and ventilator-associated pneumonia.
Keywords
InfectionMicrobiome
Pneumonia
Ventilator-associated pneumonia
Ventilator-associated tracheobronchitis
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