ULTRASTRUCTURE AND MUCOCILIARY TRANSPORT OF BRONCHIAL RESPIRATORY EPITHELIUM IN INTUBATED PATIENTS

Objective: The objective of this study was to investigate whether reduced bronchial mucus transport velocity (BTV) is associated with a loss of cilia or ultrastructural abnormalities of cilia in intubated patients. Design: The patients were studied prospectively in a convenience sample trial. Setting: The study took place in a university hospital. Patients and participants: 29 orally intubated patients in a surgical ICU. Interventions: BTV was measured with radiolabeled microspheres in the right and left primary bronchus. Following these measurements, biopsy samples were taken from the bronchi for scanning (SEM) and transmission (TEM) electron-microscopic investigations. Measurements and results: SEM: Patients with normal or slight impaired BTV (group 1, n = 14: BTV: 8.5 mm/min (3.8-11.5); median with range) showed more cilia on the luminal surface than patients with markedly depressed BTV (p < 0.05) (group 2, n = 15: BTV: 0 (0-2.1)). The difference was statistically significant. The BTV values correlated moderately with the number of cilia on the luminal surface (r = 0.46; p = 0.02). TEM: In group 1, 6.5% (3.9-14.9) of cilia were abnormal (median with range) vs 9.3% (4.9-13.7) in group 2; these differences were not statistically significant. Neither was there any significant correlation between BTV and the frequency of abnormal cilia. Conclusions: Impaired mucociliary transport in intubated patients is associated with a loss of cilia rather than ultrastructural abnormalities of cilia, which are less relevant.