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VENTILATOR-ASSOCIATED TRACHEOBRONCHITIS IN A MIXED SURGICAL AND MEDICAL INTENSIVE CARE UNIT POPULATION
October 2009, Vol 136, No. 4_MeetingAbstracts Abstract: Poster Presentations | October 2009
VENTILATOR-ASSOCIATED TRACHEOBRONCHITIS IN A MIXED SURGICAL AND MEDICAL INTENSIVE CARE UNIT POPULATION John D. Dallas, MD*; Marin H. Kollef, MD; Lee Skrupky, PharmD; Scott Micek, PharmD; Nurelign Abebe, MD Washington University School of Medicine, St. Louis, MO Chest Chest. 2009;136(4_MeetingAbstracts):113S. doi:10.1378/chest.136.4_MeetingAbstracts.113S Abstract PURPOSE: Ventilator-associated tracheobronchits (VAT) has received attention as an intermediary condition between colonization of the upper respiratory tract and ventilatorassociated pneumonia (VAP). Antibiotic therapy for VAT has been touted as a method of preventing subsequent VAP. However, little is known about the incidence of VAT or outcomes associated with it. This study aims to calculate the incidence of VAT relative to VAP in a mixed medical and surgical intensive care unit (ICU) population. In addition, etiologic pathogens and clinical outcomes associated with VAT will be determined. METHODS: All patients intubated for more than 48 hours in a total of 43 ICU beds will be screened daily for the diagnosis of VAT or VAP. Clinical outcomes of patients identified as having either VAT or VAP will be recorded. Additionally, cases of VAT that progress to VAP will be analyzed. Patients with a tracheostomy will be excluded. RESULTS: After 3 months of data collection, 21 cases of VAP and 11 cases of VAT have been identified. Three cases of VAT have progressed to VAP. The overall mortality rate in the group with VAT (36.4%) is greater than the group with VAP (14.3%). However, VAP is associated with a longer length of hospital stay (25.7 versus 20.3 days) and longer length of ICU stay (14.9 versus 12.5 days). The duration of mechanical ventilation is relatively equal between the VAP (11.3 days) and the VAT (11.5 days) groups. Patients with VAT have had a lower Clinical Pulmonary Infection Score than those with VAP (6.5 versus 4.7). Multidrug resistant pathogens have caused 36.4% of VAT cases. CONCLUSION: The incidence of VAT in this study is less than that previously reported in the literature. However, the diagnosis of VAT is associated with a high rate of mortality and is freuqently caused by multidrug resistant pathogens. CLINICAL IMPLICATIONS: The use of serial endotracheal tube aspirates as a method of screening for VAT may aid in identifying at risk patients sooner and preventing adverse outcomes.
DISCLOSURE: John Dallas, No Financial Disclosure Information; No Product/Research Disclosure Information Wednesday, November 4, 2009 12:45 PM - 2:00 PM
VENTILATOR-ASSOCIATED TRACHEOBRONCHITIS IN A MIXED SURGICAL AND MEDICAL INTENSIVE CARE UNIT POPULATION John D. Dallas, MD*; Marin H. Kollef, MD; Lee Skrupky, PharmD; Scott Micek, PharmD; Nurelign Abebe, MD Washington University School of Medicine, St. Louis, MO Chest Chest. 2009;136(4_MeetingAbstracts):113S. doi:10.1378/chest.136.4_MeetingAbstracts.113S Abstract PURPOSE: Ventilator-associated tracheobronchits (VAT) has received attention as an intermediary condition between colonization of the upper respiratory tract and ventilatorassociated pneumonia (VAP). Antibiotic therapy for VAT has been touted as a method of preventing subsequent VAP. However, little is known about the incidence of VAT or outcomes associated with it. This study aims to calculate the incidence of VAT relative to VAP in a mixed medical and surgical intensive care unit (ICU) population. In addition, etiologic pathogens and clinical outcomes associated with VAT will be determined. METHODS: All patients intubated for more than 48 hours in a total of 43 ICU beds will be screened daily for the diagnosis of VAT or VAP. Clinical outcomes of patients identified as having either VAT or VAP will be recorded. Additionally, cases of VAT that progress to VAP will be analyzed. Patients with a tracheostomy will be excluded. RESULTS: After 3 months of data collection, 21 cases of VAP and 11 cases of VAT have been identified. Three cases of VAT have progressed to VAP. The overall mortality rate in the group with VAT (36.4%) is greater than the group with VAP (14.3%). However, VAP is associated with a longer length of hospital stay (25.7 versus 20.3 days) and longer length of ICU stay (14.9 versus 12.5 days). The duration of mechanical ventilation is relatively equal between the VAP (11.3 days) and the VAT (11.5 days) groups. Patients with VAT have had a lower Clinical Pulmonary Infection Score than those with VAP (6.5 versus 4.7). Multidrug resistant pathogens have caused 36.4% of VAT cases. CONCLUSION: The incidence of VAT in this study is less than that previously reported in the literature. However, the diagnosis of VAT is associated with a high rate of mortality and is freuqently caused by multidrug resistant pathogens. CLINICAL IMPLICATIONS: The use of serial endotracheal tube aspirates as a method of screening for VAT may aid in identifying at risk patients sooner and preventing adverse outcomes.
DISCLOSURE: John Dallas, No Financial Disclosure Information; No Product/Research Disclosure Information Wednesday, November 4, 2009 12:45 PM - 2:00 PM