Ventilator-associated tracheobronchitis

Purpose of Review: This review focuses on the pathophysiology of proximal airway infection in the ventilated patient. Ventilator-associated tracheobronchitis (VAT) is increasingly recognized as an important entity not only as an essential step in the pathway from oral colonization to deep lung infection but also as an infection associated with its own morbidity. Recent Findings: Multiple recent clinical trials have focused on the effects of new devices and treatment protocols on the morbidity associated with the progression of airway colonization to VAT or with the progression of VAT to VAP. Continuous subglottic secretion suctioning (CASS), innovative types of endotracheal tubes, and targeted therapy for VAT in recent investigations have shown promise in improving clinical outcomes in the critically ill patient. However, even with diligent attention to all the modifiable risk factors for respiratory infection, complete elimination of VAT and VAP remains unlikely. As long as a patient requires an endotracheal tube which disturbs airway integrity, host defenses will be impaired, and resistant virulent organisms which result from our liberal use of systemic antibiotics will continue to challenge critical care specialists. Summary: This review will focus on: 1) the current understanding of the pathogenesis of VAT, 2) modifiable risk factors, and 3) new approaches to treatment and bacterial resistance challenges.