الفهرس 
Ventilator-associated TracheobronchitisOnly 14 pages are availabe for public view
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Abstract
Mechanical ventilation (MV), while lifesaving, also carries significant risks and complications. In intensive care units (ICU), ventilator-associated tracheobronchitis (VAT) is a relatively common problem with a significantincidence among different series. Not all patients get tracheobronchitis while on the ventilator, but those that do, develop longer length of ICU stay (LOS) and a prolonged need for mechanical ventilation. VAP remains the leading nosocomial infection in the ICU being associated with increased morbidity, antibiotic use, health care resources, and costs.
Both, VAT and VAP are recognized clinically by fever, an increase in the volume and purulence of the lower respiratory tract secretions and leukocytosis, and in contrast to VAP, VAT does not involve the pulmonary parenchyma and, thus, does not cause radio- graphic pulmonary infiltrates therefore its diagnosis is difficult and represents more a clinical approach rather than a rigid definition.
Over the past decade, the incidence of lower respiratory tract infection due to multidrug resistant (MDR) pathogens, such as methicillin-resistant Staphylococcus aureus, and gram-negative bacilli has been increasing. On the basis of these data, the 2005 American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) guidelines for management of VAP emphasized the importance of early, appropriate, empirical antibiotic therapy based on patient risk factors for infection due to MDR pathogens to improve patient outcomes. This empirical regimen was followed by de-escalation when specific microbiologic data became available 48–72 h later.
Potential disadvantages of the empirical ATS/IDSA model include excessive use of multiple empirical antibiotic therapies, which may increase antibiotic resistance; toxicity andfailureto properly deescalate when culture data become available.
Fifty patients were included in the present study; the patients who were intubated for more than 48 hrs postoperatively were followed up for the development of VAT and/or VAP by using both the radiological methods (chest x-ray) and microbiological methods .
The study excluded patients who were immune compromised or with chronic respiratory disease (either obstructive or restrictive) so as to study the impact of postoperative mechanical ventilation on patients without the influence of respiratory diseases.
The incidence of VAP was much higher than the incidence of VAT but both showed to increase the duration of MV, AB use and ICU stay when compared to the group intubated without development of VAT or VAP.
The lower incidence of VAT (10%) compared with VAP (24%) in the current study was similar to previous studies. This could be explained by the recent hypothesis that suggest that VAT is not necessarily a precursor of VAP, but that both VAT and VAP are two distinct entities that can arise from the non-infected state and can either coexist or exist separately. However, the progression from colonization to VAT and, in some cases, to VAP or occurrence of de novo VAP will always depend on the quantity and virulence of the bacterial pathogen, and alveolar and airway host defenses.
Among all types of surgeries cardiothoracic surgery and neurosurgery were associated with the higher incidence of VAT in the current study.This could be explained by the longer duration of intubation expected with those patients with post-operative hemodynamic instability or alteration of conscious level.
There was no significant difference among the individual causative bacterial pathogens for patients with VAT compared to patient with VAP in our study comparable results. However, pseudomonas aeruginosa was the most common bacteria (40%) in VAT patients in accordance with previous studies. VAT is frequently caused by Gram-negative bacteria in particular pseudomonas aeruginosa.
“Prevention is better than treatment “ was always a great timeless rule in medicine in general and certainly this study was not an exception from that rule. Early optimization and stabilization of the patient condition with early extubation are the first line in the battle of fighting infections associated with mechanical ventilation.