Ventilator-associated tracheobronchitis: where are we now? - Critical Care Science (CCS)
Ventilator-associated tracheobronchitis (VAT) is a common intensive care unit (ICU)-acquired infection. Its incidence ranges from 1.4 to 19% of critically ill patients receiving invasive mechanical ventilation.( – ) This infection is considered as an intermediate process between colonization and ventilator-associated pneumonia (VAP).( ) Histological studies revealed a continuum between these two infections. Several definitions are available for VAT. However, all of these definitions have some limitations. The most accepted and frequently used definition include the following criteria: fever >38º C with no other cause, purulent tracheal secretions, positive tracheal aspirate (≥105cfu/mL), and absence of new infiltrate on chest X-ray.( ) VAT is frequently caused by Gram-negative bacilli. Pseudomonas aeruginosa, Staphylococcus aureus, and Acinetobacter baumannii are the most common pathogens isolated from respiratory secretions of VAT patients.( )
Previous studies have reported a prolonged duration of mechanical ventilation and a prolonged ICU stay in VAT patients.( , ) This negative impact on patient outcome is related to increased inflammation of the lower respiratory tract and sputum production. Extubation failure has been noted, and difficult weaning could result from increased sputum production. In addition, higher rates of VAP were reported in patients with VAT compared with those without VAT. In a recent multicenter observational study conducted in 122 VAT patients,( ) the incidence of VAP was two-fold higher in patients with VAT compared with those without VAT (13.9% versus 7%). Although the mortality attributed to VAP remains a matter for debate, VAP is associated with a longer duration of mechanical ventilation, longer length of ICU stay, and increased hospital cost.( )
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Ventilator-associated tracheobronchitis (VAT) is a common intensive care unit (ICU)-acquired infection. Its incidence ranges from 1.4 to 19% of critically ill patients receiving invasive mechanical ventilation.( - ) This infection is considered as an intermediate process between colonization and ventilator-associated pneumonia (VAP).( ) Histological studies revealed a continuum between these two infections. Several definitions are available for VAT. However, all of these definitions have some limitations. The most accepted and frequently used definition include the following criteria: fever >38º C with no other cause, purulent tracheal secretions, positive tracheal aspirate (≥105cfu/mL), and absence of new infiltrate on chest X-ray.( ) VAT is frequently caused by Gram-negative bacilli. Pseudomonas aeruginosa, Staphylococcus aureus, and Acinetobacter baumannii are the most common pathogens isolated from respiratory secretions of VAT patients.( )
Previous studies have reported a prolonged duration of mechanical ventilation and a prolonged ICU stay in VAT patients.( , ) This negative impact on patient outcome is related to increased inflammation of the lower respiratory tract and sputum production. Extubation failure has been noted, and difficult weaning could result from increased sputum production. In addition, higher rates of VAP were reported in patients with VAT compared with those without VAT. In a recent multicenter observational study conducted in 122 VAT patients,( ) the incidence of VAP was two-fold higher in patients with VAT compared with those without VAT (13.9% versus 7%). Although the mortality attributed to VAP remains a matter for debate, VAP is associated with a longer duration of mechanical ventilation, longer length of ICU stay, and increased hospital cost.( )
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