Tracheobronchitis associated with tracheostomy tubes and endotracheal intubation in children
- Charles R Woods, MD, MS
Charles R Woods, MD, MS
- Professor of Pediatrics
- University of Louisville School of Medicine
- Section Editors
- Glenn C Isaacson, MD, FAAP
Glenn C Isaacson, MD, FAAP
- Section Editor — Pediatric Otolaryngology
- Professor, Departments of Otolaryngology, Head and Neck Surgery and Pediatrics
- Lewis Katz School of Medicine at Temple University
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
Children who require artificial airways (ie, tracheostomy for the management of chronic respiratory insufficiency or endotracheal intubation for an acute critical illness) are at increased risk for bacterial tracheopulmonary infections. Infections in these patients occur due to bacterial colonization of the artificial airway and mucosal injuries related to airway cannulation . Tracheobronchitis in this setting is generally characterized by clinical signs of respiratory tract infection (eg, fever, cough, increased sputum production) without radiographic evidence of pneumonia.
Tracheal infections associated with tracheostomy tubes and endotracheal intubation in children will be discussed here. The clinical features, diagnosis, treatment, and prevention of bacterial tracheitis in children and the diagnosis of ventilator-associated pneumonia are discussed separately:
- Graf J, Stein F. Tracheitis in pediatric patients. Semin Pediatr Infect Dis 2006; 17:11.
- Jones R, Santos JI, Overall JC Jr. Bacterial tracheitis. JAMA 1979; 242:721.
- Nseir S, Ader F, Marquette CH. Nosocomial tracheobronchitis. Curr Opin Infect Dis 2009; 22:148.
- Craven DE. Ventilator-associated tracheobronchitis (VAT): questions, answers, and a new paradigm? Crit Care 2008; 12:157.
- Brook I. Bacterial colonization, tracheobronchitis, and pneumonia following tracheostomy and long-term intubation in pediatric patients. Chest 1979; 76:420.
- Morar P, Singh V, Makura Z, et al. Oropharyngeal carriage and lower airway colonisation/infection in 45 tracheotomised children. Thorax 2002; 57:1015.
- Willson DF, Conaway M, Kelly R, Hendley JO. The lack of specificity of tracheal aspirates in the diagnosis of pulmonary infection in intubated children. Pediatr Crit Care Med 2014; 15:299.
- Niederman MS, Ferranti RD, Zeigler A, et al. Respiratory infection complicating long-term tracheostomy. The implication of persistent gram-negative tracheobronchial colonization. Chest 1984; 85:39.
- Mhanna MJ, Elsheikh IS, Super DM. Risk factors and outcome of Ventilator Associated Tracheitis (VAT) in pediatric trauma patients. Pediatr Pulmonol 2013; 48:176.
- Wheeler DS, Whitt JD, Lake M, et al. A Case-Control Study on the Impact of Ventilator-Associated Tracheobronchitis in the PICU. Pediatr Crit Care Med 2015; 16:565.
- Muszynski JA, Sartori J, Steele L, et al. Multidisciplinary quality improvement initiative to reduce ventilator-associated tracheobronchitis in the PICU. Pediatr Crit Care Med 2013; 14:533.
- Simpson VS, Bailey A, Higgerson RA, Christie LM. Ventilator-associated tracheobronchitis in a mixed medical/surgical pediatric ICU. Chest 2013; 144:32.
- Kun SS, Edwards JD, Ward SL, Keens TG. Hospital readmissions for newly discharged pediatric home mechanical ventilation patients. Pediatr Pulmonol 2012; 47:409.
- Morrow BM, Argent AC. Pediatric ventilator-associated tracheobronchitis and pneumonia: time to regroup? Pediatr Crit Care Med 2013; 14:553.
- Muszynski JA, Steward S, Brilli RJ. It Is Time to Care About Ventilator-Associated Tracheobronchitis. Pediatr Crit Care Med 2015; 16:593.
- Cline JM, Woods CR, Ervin SE, et al. Surveillance tracheal aspirate cultures do not reliably predict bacteria cultured at the time of an acute respiratory infection in children with tracheostomy tubes. Chest 2012; 141:625.
- Dallas J, Kollef M. VAT vs VAP: are we heading toward clarity or confusion? Chest 2009; 135:252.
- Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36:309.
- Bacterial tracheitis
- Ventilator-associated tracheobronchitis
- Artificial airway-associated tracheobronchitis
- CLINICAL FEATURES
- DIAGNOSTIC EVALUATION
- Chest imaging
- Complete blood count
- Inflammatory biomarkers
- - Gram stain
- - Culture
- DIFFERENTIAL DIAGNOSIS
- SUMMARY AND RECOMMENDATIONS