Ventilator-Associated Tracheobronchitis

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Ventilator-Associated Tracheobronchitis Donald E. Craven, MD, Alexandra Chroneou, MD, Nikolaos Zias, MD, PhD, Karin I. Hjalmarson, MD CHEST Volume 135, Issue 2, Pages 521-528 (February 2009) DOI: 10.1378/chest.08-1617 Copyright © 2009 The American College of Chest Physicians Terms and Conditions

Figure 1 Pathogenesis of bacterial lower respiration tract infections. Bacterial pathogens usually enter the lower respiratory tract from the oropharynx by leakage around the ETT tube cuff. Different prevention strategies for VAP are aimed at reducing number of bacteria entering the lower respiratory tract. The black arrow represents the “battle” between the bacterial pathogen and different host defenses. The three circles below represent potential patient outcomes that may occur over time. CHEST 2009 135, 521-528DOI: (10.1378/chest.08-1617) Copyright © 2009 The American College of Chest Physicians Terms and Conditions

Figure 2 Summary of changes in tracheal colonization over time in an intubated patient. Note increase in levels of colonization from the time of intubation until VAT (≥ 105–6 cfu/mL) was diagnosed on day 7. Targeted antibiotic therapy on day 7 resulted in a rapid decrease in tracheal colonization. CHEST 2009 135, 521-528DOI: (10.1378/chest.08-1617) Copyright © 2009 The American College of Chest Physicians Terms and Conditions

Figure 3 Potential advantages of a model based on the diagnosis and early, targeted antibiotic treatment of VAT include reduction in VAP and improved patient outcomes. This model may also help in the management of early VAP (to early for chest radiograph changes) and possible VAP that includes patients with preexisting chest radiographs with prior diffuse infiltrates that prevent confirmation of new infiltrate needed to diagnose VAP. CHEST 2009 135, 521-528DOI: (10.1378/chest.08-1617) Copyright © 2009 The American College of Chest Physicians Terms and Conditions

Figure 4 A model based on the use of serial endotracheal sputum cultures for the early detection of VAT, and the initiation of timely, targeted antibiotic therapy, which has been demonstrated to reduce or prevent VAP and improve patient outcomes.2,3. CHEST 2009 135, 521-528DOI: (10.1378/chest.08-1617) Copyright © 2009 The American College of Chest Physicians Terms and Conditions