Ventilator-associated tracheobronchitis increases the length of intensive care unit stay

Abstract

Objective: To investigate prospectively the clinical course and risk factors for ventilator-associated tracheobronchitis (VAT) and the impact of VAT on intensive care unit (ICU) morbidity and mortality.

Design: Prospective cohort study.

Setting: University Hospital Larissa, Larissa, Greece.

Patients: Critical care patients who received mechanical ventilation for more than 48 hours were prospectively studied between 2009 and 2011.

Methods: The modified Clinical Pulmonary Infection Score, white blood cell count, and C-reactive protein level were systematically assessed every 2 days for the first 2 weeks of ICU stay. Bronchial secretions were assessed daily. Quantitative cultures of endotracheal secretions were performed on the first ICU day for every patient and every 2 days thereafter for the first 2 weeks or more at the discretion of the attending physicians. Definition of VAT was based on previously published criteria.

Results: A total of 236 patients were observed; 42 patients (18%) presented with VAT. Gram-negative pathogens, which were usually multidrug resistant, were responsible for 92.9% of cases. Patients with a neurosurgical admission presented with VAT significantly more often than did other ICU patients (28.5% vs 14.1%; . The occurrence P=.02) of VAT was a significant risk factor for increased duration of ICU stay (OR [95% CI], 3.04 [1.35–6.85]; P=.01). Age (OR [95% CI], 1.04 [1.015–1.06]; P=.02), Acute Physiology and Chronic Health Evaluation II score (OR [95% CI], 1.08 [1.015–1.16]; P=.02), and C-reactive protein level at admission (OR [95% CI], 1.05 [1.01–1.1]; P=.02) were independent factors for ICU mortality.

Conclusions: VAT is a nosocomial infection that might be associated with prolonged stay in the ICU, especially in neurocritical patients. VAT was not associated with increased mortality in our study.