Incidence and Outcomes of Ventilator-associated Tracheobronchitis and Pneumonia

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• 作者：Donald E. Craven ; MD^a ; ^b ; ^{donald.e.craven@lahey.org} ; Yuxiu Lei ; PhD^a ; ^c ; Robin Ruthazer ; MPH^d ; Akmal Sarwar ; MD^c ; Jana Hudcova ; MD^b ; ^e
• 关键词：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
• 刊名：The American Journal of Medicine
• 出版年：2013
• 出版时间：June, 2013
• 年：2013
• 卷：126
• 期：6
• 页码：542-549
• 全文大小：510 K

文摘

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 ¡Ý48 hours for the development of tracheobronchitis defined as quantitative endotracheal aspirate ¡Ý10⁵ 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 ¡Ý10⁵ 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 ¡Ü.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.