The following is a summary of “Evolution of Tracheobronchial Colonization Following Tracheal Intubation in Patients With Neurologic Injury Who Are Ventilated: INSPIRE Study,” published in the April 2024 issue of Critical Care by Danche et al.

Limited studies exist on endotracheal secretion characteristics and the course in patients under mechanical ventilation (MV) susceptible to ventilator-associated pneumonia (VAP).

Researchers conducted a retrospective study investigating the comprehensive characterization of endotracheal secretions and their potential to predict VAP in patients under MV.

They enrolled neurologically injured patients requiring MV for at least 7 days. Patients with pulmonary or infectious conditions were excluded. A comprehensive analysis was performed on all endotracheal aspirates (ETAs) collected at regular intervals between tracheal intubation and day 7 post-intubation. Both the macroscopic features and microbial content of the ETAs were evaluated. Additionally, daily assessments included calculating the Clinical Pulmonary Infection Score (CPIS). An independent committee with blinded adjudication confirmed all VAP diagnosis.

The result showed 48 patients and 1,544 ETAs, of which 81% were classified as purulent, while 50% exhibited a thick consistency. Microbiological cultures revealed significant variability between patients (interindividual) and within individual patients over time (intraindividual). The VAP was developed in only 10 (21%) patients. An elevated CPIS exceeding 6 was observed in 8 patients (80%) with VAP and 14 patients (37%) without VAP. A 20 mL increase in ETA volume on the day preceding VAP diagnosis demonstrated promising results, with a sensitivity of 67% and a specificity of 93% for detecting VAP.

Investigators concluded that the dynamic nature of respiratory colonization patients with MV, with limited predictive value of ETA characteristics and traditional VAP scores, suggested increased secretion volume as a potential marker for VAP development.

Source: chestcc.org/article/S2949-7884(24)00029-7/