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(Chest. 2005;128:2772-2777.)
© 2005 American College of Chest Physicians

Mucociliary Clearance Is Impaired in Acutely Ill Patients*

Naomi Kondo Nakagawa, PhD; Michelle Lisidati Franchini, BSc; Patrícia Driusso, PhD; Luciana Rabello de Oliveira, BSc; Paulo Hilário Nascimento Saldiva, MD, PhD and Geraldo Lorenzi-Filho, MD, PhD

* From the University of São Paulo City UNICID; Department of Pathology, Medical School, University of São Paulo; and Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.

Correspondence to: Naomi Kondo Nakagawa, PhD, Av. Dr. Arnaldo, 455 sala 1223, Cerqueira César, São Paulo, SP, CEP: 01246–903, São Paulo, Brazil; e-mail: naomikondo{at}uol.com.br

Objective: This study aimed to investigate nasal mucociliary clearance in acutely ill patients who were clinically stable and had no airway manipulation.

Design: Prospective clinical study.

Setting: Medical ICU.

Patients and participants: Sixteen medical patients admitted to the ICU and 16 healthy subjects were studied. Patients who were receiving airway manipulation, including tracheal suctioning, nasogastric or enteral tubes, noninvasive and invasive mechanical ventilation, were excluded.

Interventions: Mucociliary clearance was evaluated by saccharine transit time (STT) measurements at ICU admission (admission) and 90 days after hospital discharge (recovery). Healthy subjects were also subjected to two measurements 90 days apart.

Measurements and results: The STT of patients was 26.4 ± 11.3 min and 17.9 ± 8.6 min at admission and recovery (p = 0.002) [mean ± SD] but did not change along the 90-day interval in healthy subjects (17.2 ± 10.2 min and 16.7 ± 10.3 min), respectively. Smokers (patients and healthy subjects) presented prolonged STT when compared to nonsmokers (p = 0.026). STT at admission correlated positively with heart rate (r = 0.560; p = 0.024) and hospital stay (r = 0.634; p = 0.008).

Conclusion: Mucociliary clearance is impaired in stable acutely ill patients with no airway manipulation and correlates with simple markers of underlying disease severity. Mucociliary dysfunction may help to explain the increased susceptibility of hospital-acquired respiratory infection in critically ill patients.

Key Words: ICU • mucociliary transport • saccharine transit time • tobacco smoking






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