Incidence and Outcomes of Ventilator-associated Tracheobronchitis and Pneumonia - 18/05/13
Abstract |
Background |
Prolonged intubation with mechanical ventilation carries a risk for ventilator-associated respiratory infections manifest as tracheobronchitis or pneumonia. This study analyzed natural history, incidence, and outcomes of patients developing ventilator-associated tracheobronchitis and pneumonia.
Methods |
We studied 188 mixed intensive care unit (ICU) patients intubated ≥48 hours for the development of tracheobronchitis defined as quantitative endotracheal aspirate ≥105 cfu/mL plus at least 2 clinical criteria (fever, leukocytosis, or purulent sputum). Pneumonia was defined as microbiologic criteria for tracheobronchitis and a new and persistent infiltrate on chest radiograph.
Results |
Airways of 41 (22%) patients became heavily colonized with a bacterial pathogen(s) at a concentration of ≥105 cfu/mL. Tracheobronchitis developed in 21 (11%) study patients, of which 6 (29%) later progressed to pneumonia. Including these 6 patients, 28 (15%) study patients developed pneumonia. Multidrug-resistant pathogens were isolated in 39% of pneumonia patients. Patients with tracheobronchitis and pneumonia had significantly more ventilator days and longer stays in the ICU (P ≤.02).
Conclusions |
Approximately one third of tracheobronchitis patients later developed pneumonia. Patients with tracheobronchitis or pneumonia experienced significantly more ventilator days and longer ICU stays, but had no difference in mortality. Better patient outcomes and reduced health care costs may be achieved by earlier treatment of ventilator-associated respiratory infections, manifest as tracheobronchitis or pneumonia.
Le texte complet de cet article est disponible en PDF.Keywords : Ventilator-associated pneumonia (VAP), Ventilator-associated tracheobronchitis (VAT), Ventilator-associated respiratory infections (VARI), Outcomes of ventilator-associated respiratory infections, Prevention of VAP, Diagnosis of VAT and VAP
Plan
Funding: This study was funded by the Lahey Clinic, the Wise Foundation, and a grant from Pfizer Pharmaceuticals. |
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Conflict of Interest: DEC has received grant support from the Wise Foundation, the Lahey Clinic, and Pfizer Pharmaceuticals and is on the Speakers' Bureaus of Merck, Covidien, Sanofi-Pasteur, and Pfizer. All other authors report no potential conflicts of interest. |
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Authorship: All authors had access to the data and played a role in writing this manuscript. |
Vol 126 - N° 6
P. 542-549 - juin 2013 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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