Incidence and Outcomes of Ventilator-associated Tracheobronchitis and Pneumonia

Craven, Donald E.; Y, Lei; Ruthazer, Robin; Sarwar, Arslan; Hudcova, Jana

doi:10.1016/j.amjmed.2012.12.012

Cited by 87 publications

(79 citation statements)

References 37 publications

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“…Se había reportado baja ocurrencia de TAV 2 y nosotros encontramos alta frecuencia al compararse con NAV. La necesidad de dar tratamiento temprano para cambiar el curso clínico y evitar la mortalidad por NAV 15 no pudo ser validada por nuestra investigación.…”

Section: Discussionunclassified

Traqueobronquitis y neumonía asociadas a ventilación mecánica en unidades de cuidado intensivo de Latinoamérica: epidemiología, curso clínico y desenlaces (Estudio LATINAVE)

Alí-Munive

Hernández-Parra

Molina

et al. 2017

Infect

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Cómo citar este artículo: Varón-Vega FA, et al. Traqueobronquitis y neumonía asociadas a ventilación mecánica en unidades de cuidado intensivo de Latinoamérica: epidemiología, curso clínico y desenlaces (Estudio LATINAVE). Infectio 2016. http://dx.doi.org10.22354/in.v21i2.650 ResumenIntroducción: Las infecciones asociadas a ventilación mecánica son causa importante de morbimortalidad en el paciente crítico. La diferenciación entre traqueobronquitis y neumonía no es siempre fácil, y es controvertida. Algunos trabajos describen aumento de mortalidad, mayor estancia en Unidades de Cuidado Intensivo (UCI), mayor requerimiento de ventilación mecánica e incremento de costos en pacientes con traqueobronquitis asociada a ventilador (TAV), sin diferencias significativas en pacientes con neumonía asociada a ventilador (NAV). Estos estudios no describen el comportamiento clínico y epidemiológico de la TAV y la NAV como 2 entidades independientes, por lo que es necesario describirlo. Métodos: Estudio multicéntrico de cohorte prospectiva, de pacientes adultos que desarrollaron TAV o NAV durante su estancia en UCI, entre noviembre de 2013 y octubre de 2014. A cada una de las variables demográficas, clínicas, de laboratorio y de desenlace, como tiempo de ventilación mecánica, estancia hospitalaria y muerte, se le realizó análisis descriptivo; para evaluar las diferencias entre los grupos se utilizó test de chi cuadrado, t de Student o U de Mann Whitney. Resultados: Se incluyó a 143 pacientes, con edad promedio de 55 años, 57% eran hombres, de 6 países en Latinoamérica; 63% con NAV y 37% con TAV. Las comorbilidades más frecuentes fueron cardiovascular (44%) y neurológica (30%); esta última fue más frecuente en TAV (41,5 vs. 23%; p = 0,02). No se encontró diferencia en APACHE II de ingreso. El índice SOFA fue mayor en NAV (8 vs. 5; p = 0,02). No hubo diferencias en el aislamiento microbiológico, ni en los patrones de resistencia bacteriana entre las 2 entidades. Se observó mayor número de complicaciones cardiovasculares y SDRA en pacientes con NAV. No se encontró diferencia entre los 2 grupos en estancia en UCI, los días de ventilación mecánica ni en mortalidad. Conclusiones: La prevalencia de TAV fue mayor a lo descrito hasta ahora en la literatura. No se encontraron diferencias significativas en el aislamiento microbiológi-co, la resistencia bacteriana ni el esquema antibiótico utilizado en los 2 grupos. Aunque la NAV cursó con mayor proporción de complicaciones médicas asociadas, el hallazgo de una estancia hospitalaria, tiempo de ventilación mecánica y mortalidad similares sustenta la importancia clínica de la TAV. Palabras clave: Neumonía asociada a ventilador;Epidemiology, clinical evolution and outcomes of tracheobronchitis and pneumonia associated with mechanical ventilation in intensive care units of Latin America (LATINAVE study) AbstractIntroduction: The infections associated with mechanical ventilation are a major cause of morbidity and mortality in critically ill patients. Limited studies report increased mortality ...

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Section: Discussionunclassified

Traqueobronquitis y neumonía asociadas a ventilación mecánica en unidades de cuidado intensivo de Latinoamérica: epidemiología, curso clínico y desenlaces (Estudio LATINAVE)

Alí-Munive

Hernández-Parra

Molina

et al. 2017

Infect

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“…Nosocomial tracheobronchitis is common in mechanically ventilated ICU patients [30]. A recent paper reported that approximately one third of ventilator-associated tracheobronchitis (VAT) patients later developed ventilator-associated pneumonia (VAP) [31]. Our method could potentially be utilised to predict the progression to VAT, which could result in decreased numbers of VAP patients.…”

Section: Discussionmentioning

confidence: 99%

Neutrophil extracellular traps in bronchial aspirates: a quantitative analysis

et al. 2014

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Neutrophil extracellular traps (NETs) are structures composed of DNA and granular proteins, which rapidly trap and kill pathogens. The formation of NETs has been detected during infection in animal experiments, but their role in humans is unclear. The purposes of this study were to quantitatively evaluate the production of NETs during acute respiratory infection and to study the relationship between the NET length and various inflammatory mediators.We examined bronchial aspirates collected from nine intubated patients in an intensive care unit. Samples were collected at the onset of acute respiratory infection (day 0) and on days 1, 3-5, and 6-8. The NET length was visualised by immunohistochemistry and quantified using computer tracing software.The NET length was measured and compared at each time point. The length differed significantly between time points (p,0.001). NETs were significantly longer on day 1 than on day 0 (p,0.001). Neutrophils released NETs abundantly in response to respiratory infection and regression analysis showed that NET length correlated with six clinical parameters (white blood cells, platelets, lactate, CXC ligand-2, interleukin-8, and procalcitonin) as the explanatory variables.NETs in bronchial aspirates may reflect disease progression of respiratory infections. Quantification of NETs in bronchial aspirates may provide a new indicator of inflammation. @ERSpublications NET length increases with respiratory inflammation which correlates with progression of infections

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“…Despite VAP epidemiological impact, it has no valid and reliable definition and even the most widely used VAP criteria are neither sensitive nor specific (6) and lack accuracy and objectivity (7,12,13), with documented poor correlation between the clinical diagnosis of VAP and histologic examination (14). Clinical scores have been applied but none was consistent in accurately identifying VAP (15).…”

Section: Vap Definitionmentioning

confidence: 99%

“…It can hit 10% to 25% of all ICU patients (4,5), being associated with longer duration of mechanical ventilation, longer ICU and hospital stays, increased healthcare costs and increased morbidity and mortality (6,7). VAP mortality rates range from 20% to 70% with healthcare costs of $20,000 to $40,000 per patient (4,8), making it a primary focus for risk-reduction strategies (9).…”

Section: Introductionmentioning

confidence: 99%

Antibiotic consumption and ventilator-associated pneumonia rates, some parallelism but some discrepancies

Nora¹,

Póvoa²

2017

Ann. Transl. Med.

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Ventilator-associated pneumonia (VAP) is a common infection in intensive care units (ICUs) but its clinical definition is neither sensitive nor specific and lacks accuracy and objectivity. New defining criteria were proposed in 2013 by the National Healthcare Safety Network (NHSN) in order to more accurately conduct surveillance and track prevention progress. Although there is a consistent trend towards a decrease in VAP incidence during the last decade, significant differences in VAP rates have been reported and are persistently lower in NHSN and other American reports (0.0 to 4.4 VAP per 1,000 ventilator-days in 2012) compared to the European Centre for Disease Prevention and Control (ECDC) data (10 VAP per 1,000 ventilator-days in 2014). In the United States, VAP has been proposed as an indicator of quality of care in public reporting, and the threat of financial penalties for this diagnosis has put pressure on hospitals to minimize VAP rates that may lead to artificial lower values, independently of patient care. Although prevention bundles may contribute for encouraging reductions in VAP incidence, both pathophysiologic and epidemiologic factors preclude a zero-VAP rate. It would be expected from the trend of reduction of VAP incidence that the consumption of antibiotics would also decrease in particular in those hospitals with lowest VAP rates. However, ICU reports show a steadily use of antibiotics for nosocomial pneumonia in 15% of patients and both ECDC and NHSN data on antibiotic consumption showed no significant trend. Knowledge of bacterial epidemiology and resistance profiles for each ICU has great relevance in order to understand trends of antibiotic use. The new NHSN criteria provide a more objective and quantitative data based VAP definition, including an antibiotic administration criterion, allowing, in theory, a more comprehensive assessment and a reportable benchmark of the observed VAP and antibiotic consumption variability.

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Incidence and Outcomes of Ventilator-associated Tracheobronchitis and Pneumonia

Cited by 87 publications

References 37 publications

Traqueobronquitis y neumonía asociadas a ventilación mecánica en unidades de cuidado intensivo de Latinoamérica: epidemiología, curso clínico y desenlaces (Estudio LATINAVE)

Traqueobronquitis y neumonía asociadas a ventilación mecánica en unidades de cuidado intensivo de Latinoamérica: epidemiología, curso clínico y desenlaces (Estudio LATINAVE)

Neutrophil extracellular traps in bronchial aspirates: a quantitative analysis

Antibiotic consumption and ventilator-associated pneumonia rates, some parallelism but some discrepancies

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