Ventilator-associated tracheobronchitis in a surgical ICU population

Abstract

Ventilator-associated tracheobronchitis (VAT) rates in the ICU are variable and may depend on the population examined. The overlap between VAT and ventilator-associated pneumonia (VAP) remains poorly defined. This study aims to determine the incidence of VAT and its relation to VAP in the surgical ICU. Patients who were intubated postoperatively for more than 48 h in surgical ICUs of the Ain Shams University Hospital were monitored daily for the development of VAT and VAP during a 2-year period. Patients were followed until ICU discharge or death. Patient demographics, causative pathogens and clinical outcomes were recorded. Among the 50 patients studied, there were five (10%) patients with VAT and 12 (24%) patients with VAP. VAT progressed to VAP in two patients (40%) despite antibiotic therapy. The incidence of VAP was significantly greater than the incidence of VAT. The mean onset times of VAT and VAP were 4 ± 1 and 5.1 ± 0.8 days, respectively. VAT and VAP were caused by multidrug-resistant pathogens in two patients (40%) and six patients (50%), respectively. VAT occurrence was the most common among patients undergoing cardiothoracic surgery and neurosurgery. There was no significant difference in the duration of mechanical ventilation and ICU stay and days of antibiotic use between the VAT and the VAP groups. There was no significant difference in the ICU mortality between patients with VAP and VAT (33.3 vs. 40%; P = 0.70). VAT occurs less commonly than VAP. VAT does not appear to be a necessary precursor for all VAP cases. VAT patients had outcomes similar to those with VAP.