In contrast to VAP, VAT does not involve the pulmonary parenchyma and, as a result, does not cause radiographic pulmonary infiltrates. īoth VAP and VAT are clinically characterized by presence of fever, mucopurulent bronchial secretions, and leukocytosis. However, more recent data suggests that VAT may be a separate entity that may contribute to increased length of ICU stay and longer duration of MV. Ventilator-associated tracheobronchitis (VAT) is believed to be an intermediate stage between colonization of the lower respiratory tract and VAP. Of these, ventilator-associated pneumonia (VAP) is one of the most severe, being associated with increased morbidity and duration of MV in the intensive care unit (ICU). Given 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.Īlthough mechanical ventilation (MV) is potentially life-saving, it also carries significant risks and complications. 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). 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). Approximately half (50.3%) of the respondents agreed that patients should receive antibiotics for the treatment of VAT. 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. ResultsĪ 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). We 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. 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. Several aspects of ventilator-associated tracheobronchitis (VAT)-including diagnostic criteria, overlap with ventilator-associated pneumonia (VAP), and appropriate treatment regimens-remain poorly defined.
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