Nseir Saad, Favory Raphaël, Jozefowicz Elsa, Decamps Franck, Dewavrin Florent, Brunin Guillaume, Di Pompeo Christophe, Mathieu Daniel, Durocher Alain
Réanimation Médicale, boulevard du Pr Leclercq, Hôpital Calmette, CHRU de Lille, 59037 Lille Cedex, France.
Crit Care. 2008;12(3):R62. doi: 10.1186/cc6890. Epub 2008 May 2.
Ventilator-associated tracheobronchitis (VAT) is associated with increased duration of mechanical ventilation. We hypothesized that, in patients with VAT, antibiotic treatment would be associated with reduced duration of mechanical ventilation.
We conducted a prospective, randomized, controlled, unblinded, multicenter study. Patients were randomly assigned (1:1) to receive or not receive intravenous antibiotics for 8 days. Patients with ventilator-associated pneumonia (VAP) prior to VAT and those with severe immunosuppression were not eligible. The trial was stopped early because a planned interim analysis found a significant difference in intensive care unit (ICU) mortality.
Fifty-eight patients were randomly assigned. Patient characteristics were similar in the antibiotic (n = 22) and no antibiotic (n = 36) groups. Pseudomonas aeruginosa was identified in 32% of VAT episodes. Although no difference was found in mechanical ventilation duration and length of ICU stay, mechanical ventilation-free days were significantly higher (median [interquartile range], 12 [8 to 24] versus 2 [0 to 6] days, P < 0.001) in the antibiotic group than in the no antibiotic group. In addition, subsequent VAP (13% versus 47%, P = 0.011, odds ratio [OR] 0.17, 95% confidence interval [CI] 0.04 to 0.70) and ICU mortality (18% versus 47%, P = 0.047, OR 0.24, 95% CI 0.07 to 0.88) rates were significantly lower in the antibiotic group than in the no antibiotic group. Similar results were found after exclusion of patients with do-not-resuscitate orders and those randomly assigned to the no antibiotic group but who received antibiotics for infections other than VAT or subsequent VAP.
In patients with VAT, antimicrobial treatment is associated with a greater number of days free of mechanical ventilation and lower rates of VAP and ICU mortality. However, antibiotic treatment has no significant impact on total duration of mechanical ventilation.
ClinicalTrials.gov, number NCT00122057.
呼吸机相关性气管支气管炎（VAT）与机械通气时间延长有关。我们假设，在患有VAT的患者中，抗生素治疗与机械通气时间缩短有关。
我们进行了一项前瞻性、随机、对照、非盲、多中心研究。患者被随机分配（1:1）接受或不接受静脉抗生素治疗8天。VAT之前患有呼吸机相关性肺炎（VAP）的患者和严重免疫抑制患者不符合条件。该试验提前终止，因为一项计划中的中期分析发现重症监护病房（ICU）死亡率存在显著差异。
58例患者被随机分配。抗生素组（n = 22）和非抗生素组（n = 36）的患者特征相似。在32%的VAT发作中鉴定出铜绿假单胞菌。虽然在机械通气时间和ICU住院时间方面未发现差异，但抗生素组的无机械通气天数显著更高（中位数[四分位间距]，12[8至24]天对2[0至6]天，P < 0.001）。此外，抗生素组的后续VAP发生率（13%对47%，P = 0.011，比值比[OR]0.17，95%置信区间[CI]0.04至0.70）和ICU死亡率（18%对47%，P = 0.047，OR 0.24，95%CI 0.07至0.88）显著低于非抗生素组。在排除有不进行心肺复苏医嘱的患者以及那些随机分配到非抗生素组但因VAT或后续VAP以外的感染接受抗生素治疗的患者后，发现了类似结果。
在患有VAT的患者中，抗菌治疗与更多的无机械通气天数以及更低的VAP发生率和ICU死亡率相关。然而，抗生素治疗对机械通气总时长无显著影响。
ClinicalTrials.gov，编号NCT00122057。
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