Ventilator-associated tracheobronchitis (VAT) questions, answers, and a new paradigm 英文参考文献.docVIP

Available online /content/12/3/157 Commentary Ventilator-associated tracheobronchitis (VAT): questions, answers, and a new paradigm? Donald E Craven1,2 1Department of Infectious Diseases, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805, USA 2Tufts University School of Medicine, Boston, MA, USA Corresponding author: Donald E Craven, donald.e.craven@ Published: 18 June 2008 Critical Care 2008, 12:157 (doi:10.1186/cc6912) This article is online at /content/12/3/157 ? 2008 BioMed Central Ltd See related research by Nseir et al., /content/12/3/R62 Abstract lower respiratory tract is impeded by the endotracheal tube, patient sedation, and a reliance on mechanical suctioning rather than spontaneous coughing. The lower respiratory tract in the ventilated patient is a continuous ‘battleground’ between the numbers, types, and virulence of the incoming bacteria versus the lung’s incredible mechanical, cellular, and humoral defenses. The outcome for each patient is either lower airway colonization or shades of grey from VAT to VAP. Nosocomial lower respiratory tract infections are a common cause of morbidity and mortality in intensive care unit (ICU) patients. Although many studies have investigated the management and prevention of ventilator-associated pneumonia (VAP), few have focused on ventilator-associated tracheobronchitis (VAT). In this issue of Critical Care, Nseir and coworkers present interesting data from a randomized controlled study of antimicrobial therapy for VAT. Patients randomly assigned to antibiotic therapy had more mechanical ventilation-free days (P 0.001), fewer episodes of VAP (13% versus 47%; P 0.001), and a lower ICU mortality rate (18% versus 47%; P = 0.05) than those without antibiotic therapy. Although this study has limitations, the data suggest that VAT may be an important risk factor for VAP or overlap with early VAP. More importan