Ventilator-associated tracheobronchitis in a mixed medical/surgical pediatric intensive care unit. (Kamat)

Chest. 2013 Jan 3. doi: 10.1378/chest.12-2343. [Epub ahead of print] PMID: 23288075

BACKGROUND Adult studies have demonstrated that ventilator-associated tracheobronchitis (VAT) may be a precursor to ventilator-associated pneumonia. No published data on VAT in pediatric intensive care units (PICU) were found. The purpose of this retrospective, descriptive study is to describe the incidence, characteristics and outcomes of patients at risk for VAT and formalize a process of VAT surveillance in the PICU population.

METHODS All patients meeting criteria for VAT during 2009-2010 were reviewed and data collected on risk of mortality, index of mortality, interventions, demographic data, respiratory cultures and organisms identified.

RESULTS 645 (32.7%) patients admitted met mechanical ventilation criteria with 22 (3.4%) meeting criteria for VAT. VAT patients experienced a significantly longer mean PICU length of stay (27.6 days + 22.043 vs. 6.61 days + 7.27; p= 0.000) and higher mean total ventilator time in hours (519.31 + 457.60 hours vs. 95.60 + 138.83 hours; p = 0.000). There is a significant association between tracheostomy and VAT (p=0.000) and between chronic ventilator dependence and VAT (p=0.002). Gram negative rods accounted for 71%; staphylococcal or streptococcal species were identified as 26% of causative pathogens. Six of 25 (24%) VAT events identified two or more potentially causative pathogens; four of these (67%) were in patients with a tracheostomy.

CONCLUSION VAT occurred less frequently than reported in adult studies and no cases of VAT progressed to VAP in our population. Our results suggest that VAT is a clinically significant HAI in the PICU population.

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