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What Is New in Ventilator-Associated Tracheobronchitis?

In Intensive care units (ICU), ventilator-associated tracheobronchitis (VAT) is a relatively common problem and the differentiation between VAT and ventilator-associated pneumonia (VAP) remains controversial. The main cause to develop infection in the upper airways is the imbalance between host defenses and excess mucus that can become stagnant and serve as a medium for bacterial growth by potentially pathogenic organisms. VAT might represent an intermediate process between colonization and ventilator-associated pneumonia and probably is a continuum between bronchitis and pneumonia in mechanical ventilated patients. Recent studies have shown that bronchial/tracheal epithelial cells are functionally different and represent a first step of injury. VAT diagnosis remains difficult and controversial. VAT represents an interesting target for treatment since it may shorten the use of antibiotics and reduce cost and minimize the selective pressure on the ICU ecology. In this manuscript, pathophysiology, diagnosis and recent practices in VAT prevention and treatment are presented.