Outcomes of Mechanically Ventilated Patients With Nosocomial Tracheobronchitis

Abstract

Introduction Ventilator-associated tracheobronchitis is a condition that occurs prior to the development of ventilator-associated pneumonia among patients who have been intubated. This study aimed to determine the impact of nosocomial tracheobronchitis (NTB) related to new bacteria on the outcome in patients with chronic obstructive pulmonary disease (COPD). Methodology A prospective, observational study was conducted in the department of surgical ICU of a tertiary care hospital between May 2019 and December 2019. All patients ventilated, irrespective of age and gender, were enrolled in the study. Individuals who had nosocomial pneumonia, before or followed by NTB, were excluded. Throughout the study, endotracheal aspirates for quantitative bacterial cultures were obtained routinely on admission, weekly thereafter, and whenever NTB or nosocomial pneumonia was suspected. All data were prospectively collected by the researchers from admission day till discharge or death of the patient. The outcomes of NTB patients were compared with those without NTB. Results A total of 24 patients with NTB and 214 patients without NTB were evaluated. There were a total of 24 patients who were diagnosed with NTB and 214 patients were NTB negative. There was a dominance of the male gender in the NTB group; however, the difference was not significant. The most common complication in patients was renal failure. During hospitalization, the Aspergillus tracheobronchitis (ATB) rate was significantly higher in patients with NTB as compared to patients with no NTB, i.e., 18 (75%) vs. 80 (37.4%) (p < 0.001). The mean length of stay in patients with NTB was significantly greater than the NTB negative group (p < 0.0001). The mortality in the case group was significantly greater than in the NTB negative group, i.e., 66.67% vs. 48.50% (p = 0.03). Conclusion NTB is associated with an increased duration of mechanical ventilation and hospitalization in intensive care units. The mortality rate in the NTB group was considerably higher than in the patients who did not have NTB. Future studies can explore the interventional and management aspect of the disease, such as determining whether early administration of broad-spectrum antibiotics can help improve the prognostic outcome of patients with NTB on mechanical ventilation.

Keywords: mechanical ventilation; nosocomial tracheobronchitis; ntb; patient outcomes; ventilation.