Abstract
IntroductionSeveral aspects of ventilator-associated tracheobronchitis (VAT)—including diagnostic criteria, overlap with ventilator-associated pneumonia (VAP), and appropriate treatment regimens—remain poorly defined. The objectives of this study were to survey reported practices in the clinical and microbiological diagnosis of VAT and to evaluate perceptions of the impact of VAT on patient outcomes.MethodsWe developed a questionnaire consisting of (a) characteristics of the respondent, the ICU, and hospital; (b) current clinical and microbiological diagnostic approach; (c) empirical antibiotic therapy; and (d) the perception of physicians regarding the clinical impact of VAT and its implications.ResultsA total of 288 ICUs from 16 different countries answered the survey: 147 (51%) from the Latin American (LA) group and 141 (49%) from Spain, Portugal, and France (SPF group). The majority of respondents (n = 228; 79.2%) reported making the diagnosis of VAT based on clinical and microbiological criteria, and 40 (13.9%) by clinical criteria alone. Approximately half (50.3%) of the respondents agreed that patients should receive antibiotics for the treatment of VAT. Out of all respondents, 269 (93.4%) assume that a VAT episode increases ICU length of stay, and this perception is greater in the LA group (97.3%) than in the SPF group (89.4%, P <0.05). Half of the physicians considered that VAT increases the risk of mortality, and this perception is again greater in the LA group (58.5% versus 41.1%, P <0.05).ConclusionsGiven the possible high incidence of VAT and the perception of its importance as a risk factor for VAP and mortality, a large multicenter international prospective study would be helpful to validate a consensual definition of VAT, determine its incidence, and delineate its impact on subsequent VAP occurrence.
Highlights
Several aspects of ventilator-associated tracheobronchitis (VAT)—including diagnostic criteria, overlap with ventilator-associated pneumonia (VAP), and appropriate treatment regimens—remain poorly defined
Questionnaire We developed a web-based questionnaire with four parts (Additional file 1): (a) characteristics of the respondent and the intensive care unit (ICU) and hospital, (b) practices of clinical and microbiological diagnosis of VAT, (c) empirical antibiotic (ATB) therapy used after diagnosis, and (d) the perception of physicians regarding the clinical impact of VAT and the need for treatment
Two hundred sixty-nine (93.4%) assume that a VAT episode is associated with increased ICU length of stay, and this perception is greater in the Latin American (LA) group (97.3%) as compared with the SPF group (89.4%, P
Summary
Several aspects of ventilator-associated tracheobronchitis (VAT)—including diagnostic criteria, overlap with ventilator-associated pneumonia (VAP), and appropriate treatment regimens—remain poorly defined. The objectives of this study were to survey reported practices in the clinical and microbiological diagnosis of VAT and to evaluate perceptions of the impact of VAT on patient outcomes. More recent data suggests that VAT may be a separate entity that may Both VAP and VAT are clinically characterized by presence of fever, mucopurulent bronchial secretions, and leukocytosis. Our main objectives were to document reported practices of clinical and microbiological diagnosis of VAT and to evaluate perceptions of the impact of VAT on patient outcomes. This will serve as a first step of an international prospective study on VAT registered under number NCT01791530 (ClinicalTrials.gov)
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