Abstract
Nosocomial lower respiratory tract infections are a common cause of morbidity and mortality in intensive care unit (ICU) patients. Although many studies have investigated the management and prevention of ventilator-associated pneumonia (VAP), few have focused on ventilator-associated tracheobronchitis (VAT). In this issue of Critical Care, Nseir and coworkers present interesting data from a randomized controlled study of antimicrobial therapy for VAT. Patients randomly assigned to antibiotic therapy had more mechanical ventilation-free days (P < 0.001), fewer episodes of VAP (13% versus 47%; P < 0.001), and a lower ICU mortality rate (18% versus 47%; P = 0.05) than those without antibiotic therapy. Although this study has limitations, the data suggest that VAT may be an important risk factor for VAP or overlap with early VAP. More importantly, targeted antibiotic therapy for VAT may improve patient outcomes and become a new paradigm for prevention or early therapy for VAP.
Highlights
Most bacteria enter the lower respiratory tract by leakage of bacteria and oropharyngeal secretions around the endotracheal tube cuff, resulting in colonization, ventilator-associated tracheobronchitis (VAT), or ventilator-associated pneumonia (VAP) [2]
Diagnoses of VAP rely on distal samples of bacteria obtained from bronchoscopic and non-bronchoalveolar lavage (≥104 cfu/mL) [2] or protected specimen brush (PSB) (≥103 cfu/mL)
Definitions of VAT and VAP have been based on different sampling techniques and microbiologic thresholds, which may make discrimination between VAT and VAP difficult
Summary
Most bacteria enter the lower respiratory tract by leakage of bacteria and oropharyngeal secretions around the endotracheal tube cuff, resulting in colonization, VAT, or VAP [2]. In this issue of Critical Care, Nseir and coworkers [1] provide interesting data from a randomized trial of antibiotic therapy for ventilator-associated tracheobronchitis (VAT). The lower respiratory tract in the ventilated patient is a continuous ‘battleground’ between the numbers, types, and virulence of the incoming bacteria versus the lung’s incredible mechanical, cellular, and humoral defenses.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
