Lung Microbiota Analysis in Critically Ill Patients Admitted to the Intensive Care Unit.

Study Overview
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Brief Summary
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Our study aims to evaluate the relationship between the heterogeneity of pulmonary microbiota and clinical and outcome variables among critically ill patients admitted to the intensive care unit (ICU). In patients undergoing invasive mechanical ventilation, an aliquot of bronchoalveolar lavage (BAL) fluid will be used in the microbiology laboratory for the analysis of respiratory microbiota through next-generation sequencing technologies and validate computational techniques.

Detailed Description
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Traditionally, microbiological investigations and clinical trials have contributed to the definition of lower airways as a physiologically sterile district, whose microbiological balance is altered when a respiratory infectious process occur. Actually, the introduction of molecular study methods aiming at the identification of pathogens through genomic sequencing questioned the pardigm of one bug-one disease, according to which we usually tend to consider a bronchial or pulmonary infectious event as due to the pathogenic role of a single exogenous microorganism. In such a contest, there are truly few data dealing with the characterization of respiratory microbiota in human BAL as well as with the major determinants of this phenomenon and the possible impact on clinical and microbiological outcomes. Our study, although it's a pilot one, aims to evaluate these aspects in a larger cohort of critically ill patients, observing the relationship between the heterogeneity of pulmonary microbiota and clinical and outcome variables. In patients undergoing invasive mechanical ventilation, an aliquot of BAL fluid will be used in the microbiology laboratory for the analysis of respiratory microbiota through next-generation sequencing technologies and validate computational techniques. For each enrolled patient, we will register demographic, clinical and laboratory variables. The benefits deriving from this study lay in the possibility of improving the understanding of characteristics of critical patient's pulmonary microbioma and its clinical impact. Such an information meets the increasingly topical need to customize medical interventions, especially in the context of critically ill patients.

Official Title
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Analysis of the Pulmonary Microbiota in a Cohort of Critically Ill Patients Admitted to the Intensive Care Unit. Prospective, Observational Trial.

Conditions
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Lung Microbiota

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: execution of bronchoalveolar lavage sampling, either for clinical indications or in the context of surveillance programs acquisition of an informed consent Exclusion Criteria: presence of significant coagulation abnormalities and/or severe respiratory failure clearly bloody BAL sample small quantity of BAL sample (<5 ml)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Description of the biodiversity of pulmonary microbioma in a cohort of critically ill ICU patients | This aim will be achieved through the use of next-generation sequencing technologies and validate computational techniques, allowing us to taxonomically classify as well as to compare the germs present in BAL samples of ICU patients | 36 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinical cure, defined by the discontinuation (> 72 hours) from mechanical ventilation | Relate composition and biodiversity of pulmonary microbioma with the occurence and time of clinical cure | 36 months | 
| Microbiological eradication, defined by a sterile BAL | Relate composition ad biodiversity of pulmonary microbioma with the occurrence and time of microbiological eradication | 36 months | 
| Duration of mechanical ventilation, in days | Relate composition ad biodiversity of pulmonary microbioma with the duration of mechanical ventilation | 36 months | 
| Duration of cathecolamins administration, in days | Relate composition ad biodiversity of pulmonary microbioma with the duration of cathecolamins administration | 36 months | 
| Hospital and ICU lenght of stay, in days | Relate composition ad biodiversity of pulmonary microbioma with hospital and ICU lenght of stay | 36 months | 
| Mortality at 28 and 90 days | Relate composition ad biodiversity of pulmonary microbioma with mortality at 28 and 90 days | 36 months |