Ventilator-associated tracheobronchitis: an update

Salluh, Jorge I.; Souza-Dantas, Vicente Cés de; Martín‐Loeches, Ignacio; Lisboa, Thiago; Rabello, Lígia Sarmet Cunha Farah; Nseir, Saad; Póvoa, Pedro

doi:10.5935/0103-507x.20190079

Cited by 8 publications

(5 citation statements)

References 39 publications

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“…The radiology criterion of a pulmonary infiltrate was excluded due to the nature of COVID‐19. Patients fulfilling the criteria but lacking a positive distal quantitative sample but presenting a positive culture from more proximal airways (i.e., tracheal secretion) were defined as VAT 22 . Early VAP was defined as onset within 4 days from intubation and late‐VAP as onset after more than 4 days 23 .…”

Section: Methodsmentioning

confidence: 99%

“…Patients fulfilling the criteria but lacking a positive distal quantitative sample but presenting a positive culture from more proximal airways (i.e., tracheal secretion) were defined as VAT. 22 Early VAP was defined as onset within 4 days from intubation and late-VAP as onset after more than 4 days. 23 Antibiotics at intubation were defined as antibiotic treatment started upon or before intubation, and still ongoing at intu-…”

Section: Setting and Study Designmentioning

confidence: 99%

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Risk factors for ventilator‐associated lower respiratory tract infection in COVID‐19, a retrospective multicenter cohort study in Sweden

Forsberg,

Taxbro,

Elander

et al. 2023

Acta Anaesthesiol Scand

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BackgroundVentilator‐associated lower respiratory tract infections (VA‐LRTI) increase morbidity and mortality in intensive care unit (ICU) patients. Higher incidences of VA‐LRTI have been reported among COVID‐19 patients requiring invasive mechanical ventilation (IMV). The primary objectives of this study were to describe clinical characteristics, incidence, and risk factors comparing patients who developed VA‐LRTI to patients who did not, in a cohort of Swedish ICU patients with acute hypoxemic respiratory failure due to COVID‐19. Secondary objectives were to decipher changes over the three initial pandemic waves, common microbiology and the effect of VA‐LTRI on morbidity and mortality.MethodsWe conducted a multicenter, retrospective cohort study of all patients admitted to 10 ICUs in southeast Sweden between March 1, 2020 and May 31, 2021 because of acute hypoxemic respiratory failure due to COVID‐19 and were mechanically ventilated for at least 48 h. The primary outcome was culture verified VA‐LRTI. Patient characteristics, ICU management, clinical course, treatments, microbiological findings, and mortality were registered. Logistic regression analysis was conducted to determine risk factors for first VA‐LRTI.ResultsOf a total of 536 included patients, 153 (28.5%) developed VA‐LRTI. Incidence rate of first VA‐LRTI was 20.8 per 1000 days of IMV. Comparing patients with VA‐LRTI to those without, no differences in mortality, age, sex, or number of comorbidities were found. Patients with VA‐LRTI had fewer ventilator‐free days, longer ICU stay, were more frequently ventilated in prone position, received corticosteroids more often and were more frequently on antibiotics at intubation. Regression analysis revealed increased adjusted odds‐ratio (aOR) for first VA‐LRTI in patients treated with corticosteroids (aOR 2.64 [95% confidence interval [CI]] [1.31–5.74]), antibiotics at intubation (aOR 2.01 95% CI [1.14–3.66]), and days of IMV (aOR 1.05 per day of IMV, 95% CI [1.03–1.07]). Few multidrug‐resistant pathogens were identified. Incidence of VA‐LRTI increased from 14.5 per 1000 days of IMV during the first wave to 24.8 per 1000 days of IMV during the subsequent waves.ConclusionWe report a high incidence of culture‐verified VA‐LRTI in a cohort of critically ill COVID‐19 patients from the first three pandemic waves. VA‐LRTI was associated with increased morbidity but not 30‐, 60‐, or 90‐day mortality. Corticosteroid treatment, antibiotics at intubation and time on IMV were associated with increased aOR of first VA‐LRTI.

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Section: Methodsmentioning

confidence: 99%

Section: Setting and Study Designmentioning

confidence: 99%

Risk factors for ventilator‐associated lower respiratory tract infection in COVID‐19, a retrospective multicenter cohort study in Sweden

Forsberg,

Taxbro,

Elander

et al. 2023

Acta Anaesthesiol Scand

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“…These entities were diagnosed using the definition of IDSA/ATS guidelines ( 15 ). The IDSA guideline criteria were also followed to assess the diagnosis of other infectious complications, including catheter-associated urinary tract infection (CA-UTI), surgical site infection (SSI), and catheter-related bloodstream infection (CRBSI) ( 16 – 18 ). TBI severity was determined using the Glasgow Coma Scale (GCS).…”

Section: Methodsmentioning

confidence: 99%

Risk factors and outcomes of lower respiratory tract infections after traumatic brain injury: a retrospective observational study

et al. 2023

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BackgroundTraumatic brain injury (TBI) is a public health problem with a high burden in terms of disability and death. Infections are a common complication, with respiratory infections being the most frequent. Most available studies have addressed the impact of ventilator-associated pneumonia (VAP) after TBI; therefore, we aim to characterize the hospital impact of a broader entity, lower respiratory tract infections (LRTIs).MethodsThis observational, retrospective, single-center cohort study describes the clinical features and risk factors associated with LRTIs in patients with TBI admitted to an intensive care unit (ICU). We used bivariate and multivariate logistic regressions to identify the risk factors associated with developing LRTI and determine its impact on hospital mortality.ResultsWe included 291 patients, of whom 77% (225/291) were men. The median (IQR) age was 38 years (28–52 years). The most common cause of injury was road traffic accidents 72% (210/291), followed by falls 18% (52/291) and assault at 3% (9/291). The median (IQR) Glasgow Coma Scale (GCS) score on admission was 9 (6–14), and 47% (136/291) were classified as severe TBI, 13% (37/291) as moderate TBI, and 40% (114/291) as mild TBI. The median (IQR) injury severity score (ISS) was 24 (16–30). Nearly 48% (141/291) of patients presented at least one infection during hospitalization, and from those, 77% (109/141) were classified as LRTIs, which included tracheitis 55% (61/109), ventilator-associated pneumonia (VAP) 34% (37/109), and hospital-acquired pneumoniae (HAP) 19% (21/109). After multivariable analysis, the following variables were significantly associated with LRTIs: age (OR 1.1, 95% CI 1.01–1.2), severe TBI (OR 2.7, 95% CI 1.1–6.9), AIS thorax (OR 1.4, 95 CI 1.1–1.8), and mechanical ventilation on admission (OR 3.7, 95% CI 1.1–13.5). At the same time, hospital mortality did not differ between groups (LRTI 18.6% vs. No LRTI 20.1%, p = 0.7), and ICU and hospital length of stay (LOS) were longer in the LRTI group (median [IQR] 12 [9–17] vs. 5 [3–9], p < 0.01) and (median [IQR] 21 [13–33] vs. 10 [5–18], p = 0.01), respectively. Time on the ventilator was longer for those with LRTIs.ConclusionThe most common site/location of infection in patients with TBI admitted to ICU is respiratory. Age, severe TBI, thoracic trauma, and mechanical ventilation were identified as potential risk factors. LRTI was associated with prolonged ICU, hospital stay, and more days on a ventilator, but not with mortality.

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“…MV support can have several clinical complications, including ventilator-associated respiratory infections [4]. Ventilator-associated pneumonia (VAP) and ventilator-associated tracheobronchitis (VAT) are the lower respiratory tract infections affecting the trachea, bronchus, and lung [5]. These infections are responsible for mortality or morbidity in patients in intensive care [4].…”

Section: Introductionmentioning

confidence: 99%

“…The film was analyzed in its chemical structure, morphology, and adhesion to the PU. Microbicidal analysis was performed using the species S. aureus, a pathogenic microorganism responsible for most infections of the lower respiratory tract involving VAP and VAT [5].…”

Section: Introductionmentioning

confidence: 99%

Sputtering of micro-carbon-silver film (μC-Ag) for endotracheal tubes to mitigate respiratory infections

Silva

Manfroi²,

Tavares³

et al. 2023

Biomed. Mater.

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Polyurethane (PU) substrates are biocompatible materials widely used to manufacture endotracheal tubes. However, in common with other biomedical materials, they are liable to the formation of microbial films. The occurrence of pneumonia in intubated patients treated at intensive care units (ICUs) often takes the form of ventilator-associated pneumonia (VAP). The issue relates to the translocation of pathogenic microorganisms that colonize the oropharyngeal mucosa, dental plaque, stomach, and sinuses. New protective materials can provide a more effective therapeutic approach to mitigating bacterial films. This work concerns microcrystalline carbon film containing dispersed silver nanoparticles (μC-Ag) deposited on PU substrates using a physical vapor deposition (PVD) sputtering process. For the first time, carbon paper was used to produce a carbon target with holes exposing a silver disk positioned under the carbon paper, forming a single target for use in the sputtering system. The silver nanoparticles were well distributed in the carbon film. The adherence characteristics of the μC-Ag film were evaluated using a tape test technique, and EDX mapping was performed to analyze the residual particles after the tape test. The microbicidal effect of the thin film was also investigated using species S. aureus, a pathogenic microorganism responsible for most infections of the lower respiratory tract involving ventilator-associated pneumonia (VAP) and ventilator-associated tracheobronchitis (VAT). The results demonstrated that μC-Ag films on PU substrates are promising materials for mitigating pathogenic microorganisms on endotracheal tubes.

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Ventilator-associated tracheobronchitis: an update

Cited by 8 publications

References 39 publications

Risk factors for ventilator‐associated lower respiratory tract infection in COVID‐19, a retrospective multicenter cohort study in Sweden

Risk factors for ventilator‐associated lower respiratory tract infection in COVID‐19, a retrospective multicenter cohort study in Sweden

Risk factors and outcomes of lower respiratory tract infections after traumatic brain injury: a retrospective observational study

Sputtering of micro-carbon-silver film (μC-Ag) for endotracheal tubes to mitigate respiratory infections

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