Unidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; NOVA Medical School, CEDOC, Universidade Nova de Lisboa, Lisboa, Portugal.
Department of Critical Care, D'Or Institute for Research and Education, Rio De Janeiro, Brazil.
J Crit Care. 2018 Dec;48:385-389. doi: 10.1016/j.jcrc.2018.09.036. Epub 2018 Oct 2.
Ventilator-associated tracheobronchitis (VAT) has been suggested as an intermediate process between tracheobronchial colonization and ventilator-associated pneumonia (VAP) in patients receiving mechanical ventilation. The aim of this study was to evaluate the ability of C-reactive protein (CRP) and procalcitonin (PCT) to differentiate between VAT and VAP.
Pre-planned analysis of the prospective multinational TAVeM database, performed on 2960 patients receiving mechanical ventilation for >48 h, including 689 patients with VA-LRTI. Patients with the diagnosis of VAT or VAP microbiologically documented and with one measurement of CRP and/or PCT on the day of diagnosis were included.
Four hundred and four patients (mean age 63 years, 298 men, ICU mortality 40%) were studied, 207 with VAT and 197 with VAP. On the day of infection diagnosis, the median CRP was elevated in both groups but significantly higher in VAP (18 mg/dL vs. 14 mg/dL, p = .001). Median PCT was also significantly higher in VAP (2.1 ng/dL vs. 0.64 ng/d L, p < .001). Both biomarkers could not help distinguish between VAT and VAP.
Although PCT and CRP presented lower values in VAT as compared to VAP, there was a marked overlap of both biomarkers values in both VA-LRTI not allowing adequate discrimination.
呼吸机相关性气管支气管炎（VAT）被认为是接受机械通气的患者中气管支气管定植与呼吸机相关性肺炎（VAP）之间的中间过程。本研究旨在评估 C 反应蛋白（CRP）和降钙素原（PCT）在区分 VAT 和 VAP 中的能力。
对接受机械通气>48 小时的 2960 例患者的前瞻性多中心 TAVeM 数据库进行预先计划的分析，包括 689 例 VA-LRTI 患者。纳入微生物学确诊为 VAT 或 VAP 且在诊断日有 CRP 和/或 PCT 一项测量值的患者。
共纳入 404 例患者（平均年龄 63 岁，298 例男性，ICU 死亡率 40%），其中 207 例为 VAT，197 例为 VAP。在感染诊断日，两组患者的 CRP 中位数均升高，但 VAP 组明显更高（18mg/dL 比 14mg/dL，p=0.001）。PCT 中位数在 VAP 组也明显更高（2.1ng/dL 比 0.64ng/dL，p<0.001）。两种生物标志物均无法帮助区分 VAT 和 VAP。
尽管与 VAP 相比，PCT 和 CRP 在 VAT 中值较低，但 VA-LRTI 中两种生物标志物的数值有明显重叠，无法进行充分区分。
