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Ventilator Associated TracheobronchitisVATICANNCT05266066

Ventilator-associated Tracheobronchitis Initiative to Conduct Antibiotic Evaluation

A study testing Clinical observation without antibiotic therapy for VAT and 7 day antibiotic course for VAT in people with Ventilator Associated Tracheobronchitis and Tracheobronchitis, run by Hospital Sirio-Libanes at 16 sites in Brazil.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

The Ventilator Associated tracheobronchitis Initiative to Conduct Antibiotic evaluation (VATICAN) trial is a national, multicenter, non-inferiority trial in ICU patients comparing antibiotic treatment for 7 days versus clinical observation without antibiotic treatment for patients with ventilator-associated… Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Clinical observation without antibiotic therapy for VAT and 7 day antibiotic course for VAT
Could I receive a placebo?
No, everyone receives an active treatment
How many people
590 participants
Where
16 sitesBrazil
Study dates
11 Jul 2022to 1 Dec 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Admission to one of the participating ICUs
  • Invasive Mechanical ventilation ≥ 48 hours
  • Available chest imaging of screening day
  • Clinical diagnosis of VAT, defined by the presence of:
  • Temperature >38.0°C or <36°C OR leukocytes >12000/mL or <4000/mL or presence >10% of immature forms, AND
  • Onset of purulent tracheal secretion, or change in characteristics of the secretion, or increase in the amount of respiratory secretion, or increased need for aspiration
Show all 10Show fewer
  • Culture of tracheal secretion from the day of screening under analysis or collected for analysis
  • Expected limitation of care or early withdrawal of supportive therapies (< 7 days)
  • Patients with a survival expectancy of less than 48 hours
  • Refusal of consent to participate in the study

Who cannot join

  • Pregnant or lactating women
  • Indication of use of antibiotics or use of systemic antibiotics for any indications at the time of screening
  • Hemodynamic instability, defined as hypotension unresponsive to volume expansion or increase in vasopressor dose > 0.1mcg/kg/min of noradrenaline or equivalent in the past 6 hours
  • Worsening of gas exchange, defined as an increase in the fraction of inspired oxygen ≥ 20% or an increase in positive end-expiratory pressure (PEEP) ≥ 3 cm of water after a stability period ≥ 2 days
  • Prolonged mechanical ventilation, defined by use of invasive mechanical ventilation for 21 days or more
  • Presence of pulmonary radiological image suggestive of new infectious infiltrate
Show all 11Show fewer
  • Previous lung disease that makes radiological interpretation for the diagnosis of VAP difficult
  • Previous diagnosis of ventilator associates pneumonia (VAP) during hospitalization
  • Neutropenic patients (neutrophils <1000/mL)
  • Known severe immunosuppression
  • Tracheostomized patients at the time of screening

Trial locations and contacts

16 sites in 1 country.

16 sites in 1 country

Brazil16 sites
  • Hospital Santa Casa de Belo Horizonte

    Belo Horizonte, Minas Gerais

  • Hospital OTOClinica

    Fortaleza, Ceará

  • Hospital Itapetininga

    Itapetininga, São Paulo

  • Hospital Unimed Limeira

    Limeira, São Paulo

  • Hospital Universitário Regional do Norte do Paraná

    Londrina, Paraná

  • Hospital Municipal de Maringá

    Maringá, Paraná

  • Hospital Vila da Serra

    Nova Lima, Minas Gerais

  • Hospital Tricentenário

    Olinda, Pernambuco

  • Santa Casa de Misericórdia de Passos

    Passos, Minas Gerais

  • Hospital Ernesto Dornelles

    Porto Alegre, Rio Grande do Sul

  • Hospital Estadual Mario Covas

    Santo André, São Paulo

  • Hospital São Joao Del Rei

    São João del Rei, Minas Gerais

  • Hospital Samaritano

    São Paulo, São Paulo

  • Hospital São Paulo

    São Paulo, São Paulo

  • Hospital Santa Casa de Sorocaba

    Sorocaba, São Paulo

  • Hospital Vila Velha

    Vila Velha, Espírito Santo

Other trials in Brazil

About this study

Official title: Multicenter Randomized Clinical Trial of Antimicrobial Treatment in Ventilator-associated Tracheobronchitis

The Ventilator Associated tracheobronchitis Initiative to Conduct Antibiotic evaluation (VATICAN) trial is a national, multicenter, non-inferiority trial in ICU patients comparing antibiotic treatment for 7 days versus clinical observation without antibiotic treatment for patients with ventilator-associated tracheobronchitis.

Read the detailed description

There is no consensus on the need for antibiotic treatment for ventilator-associated tracheobronchitis (VAT). There's a lack of high-quality clinical data on this subject, and although some observational studies recommend antibiotic treatment for VAT, some guidelines do not. The VATICAN is a prospective, randomized, single-blinded (analysis), non-inferiority trial evaluating antibiotic treatment for patients with ventilator-associated tracheobronchitis. Patients with clinically diagnosed tracheobronchitis will be randomized to receive antibiotics for 7 days versus clinical observation without antibiotic treatment for VAT. The primary hypothesis is that clinical observation without antibiotic treatment is noninferior to 7-day antibiotic course.

Being tested
Clinical observation without antibiotic therapy for VAT, 7 day antibiotic course for VAT
Keywords
Antibiotics, Ventilator associated Tracheobronchitis, Mechanical ventilation, Critically ill
Medical subject headings
Critical Illness

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Clinical observation without antibiotic therapy for VATOther

    Patients will receive standard care plus antibiotic if new organ dysfunction or new infections other than VAT.

  • 7 day antibiotic course for VATOther

    Patients will receive standard care plus 7 day course of antibiotic.

Study groups in NCT05266066
Study groupRoleWhat they receive
Clinical observation without antibiotic therapy for VATExperimentalPatients will receive standard care and no antibiotic therapy for VAT. Antibiotics will be prescribed if other infections and/or organ dysfunction ensues (especially shock) or there is progression to pneumonia
Receives: Other: Clinical observation without antibiotic therapy for VAT
7 day antibiotic course for VATActive comparatorPatients will receive standard care and 7 day course of antibiotic therapy for VAT.
Receives: Other: 7 day antibiotic course for VAT

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Ventilator free days

    Days alive and free from mechanical ventilation

    Measured: 28 days after randomization

Secondary outcomes (8)
  1. Ventilator associated pneumonia-free survival (Key secondary outcome)

    The time between randomization and the diagnostic event of ventilator associated pneumonia or death

    Measured: 28 days after randomization

  2. Mortality

    All cause mortality

    Measured: 28 days after randomization

  3. Ventilator associated pneumonia

    Ventilator associated pneumonia incidence

    Measured: 14 and 28 days after randomization

  4. Intensive care unit free days

    Days alive and free from intensive care unit

    Measured: 28 days after randomization

  5. Organ dysfunction

    Variation in organ dysfunction (measured by the Sequential Organ Failure Assessment Score). Sequential Organ Failure Assessment scores are measured in 6 organ systems (cardiovascular, hematologic, gastrointestinal, renal, pulmonary and neurologic), with each organ scored from 0 to 4, resulting in an aggregated score that ranges from 0 to 24, with higher scores indicating greater dysfunction.

    Measured: Between randomization and day 7.

  6. Microbiological isolation of multi-resistant bacteria

    Microbiological isolation of multi-resistant bacteria. Any isolation of by microbiological cultures of multi-resistant bacteria following the definition:

    Acinetobacter baumannii: Resistant to carbapenems and/or polymyxins Pseudomonas aeruginosa: Resistant to carbapenems and/or polymyxins Enterobacteriaceae: Resistant to carbapenems and/or polymyxins (in enterobacteria naturally sensitive to polymyxins) Vancomycin-resistant Enterococcus faecium (VRE) Methicillin/Oxacillin Resistant Staphylococcus aureus (MRSA) Methicillin/Oxacillin-Resistant Coagulase Negative Staphylococcus (MRSA)

    Measured: 28 days after randomization

  7. Antibiotic free days

    Days alive and free from antibiotic

    Measured: 28 days after randomization

  8. Cost analysis

    Cost effectiveness analysis. Direct and indirect hospital costs will be measured and used in the analyses. For that, a local costing system will be built, using the absorption costing methodology (top-down).

    Measured: For the first 28 days after randomization

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted4 Mar 2022
  2. Study start11 Jul 2022
  3. Primary completion1 Nov 2026 (estimated)
  4. Study completion1 Dec 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Patients will be randomized 1:1 to Clinical observation without antibiotic therapy for VAT vs. 7 day antibiotic course.
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
590 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05266066
Sponsor's protocol ID
48749421.0.1001.5461
Acronym
VATICAN
Status last verified
Jul 2026
First submitted
15 Feb 2022
Last updated
27 Jul 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Individual patient data (IPD) might be shared upon request and approval by the study committee after the study completion.

Publications

  • IMPACTO-MR, VATICAN Trial Investigators and BRICNet; Tomazini BM, Besen BAMP, Dietrich C, Gandara APR, Silva DP, Pinheiro CCG, Luz MN, Mattos RR, Reis LFL, Roepke RML, Duarte CSLG, Nassar Junior AP, Veiga VC, Arns B, Nascimento GM, Pereira AJ, Cavalcanti AB, Machado FR, Azevedo LCP. VATICAN (Ventilator-Associated Tracheobronchitis Initiative to Conduct Antibiotic Evaluation): protocol for a multicenter randomized open-label trial of watchful waiting versus antimicrobial therapy for ventilator-associated tracheobronchitis. Crit Care Sci. 2024 Aug 26;36:e20240029en. doi: 10.62675/2965-2774.20240029-en. eCollection 2024.

    PubMed 39194024
  • Tomazini BM, Nassar AP Jr, Lisboa TC, Azevedo LCP, Veiga VC, Catarino DGM, Fogazzi DV, Arns B, Piastrelli FT, Dietrich C, Negrelli KL, Jesuino IA, Reis LFL, Mattos RR, Pinheiro CCG, Luz MN, Spadoni CCDS, Moro EE, Bueno FR, Sampaio CSJC, Silva DP, Baldassare FP, Silva ACA, Veiga T, Barbante L, Lambauer M, Campos VB, Santos E, Santos RHN, Laranjeiras LN, Valeis N, Santucci E, Miranda TA, Patrocinio ACLD, Carvalho A, Sousa EMC, Sousa AHF, Malheiro DT, Bezerra IL, Rodrigues MB, Malicia JC, Silva SSD, Gimenes BDP, Sesin GP, Zavascki AP, Sganzerla D, Medeiros GS, Santos RDRMD, Silva FKR, Cheno MY, Abrahao CF, Oliveira Junior HA, Rocha LL, Nunes Neto PA, Pereira VC, Paciencia LEM, Bueno ES, Caser EB, Ribeiro LZ, Fernandes CCF, Garcia JM, Silva VFF, Santos AJD, Machado FR, Souza MA, Ferronato BR, Urbano HCA, Moreira DCA, Souza-Dantas VC, Duarte DM, Coelho J, Figueiredo RC, Foreque F, Romano TG, Cubos D, Spirale VM, Nogueira RS, Maia IS, Zandonai CL, Lovato WJ, Cerantola RB, Toledo TGP, Tomba PO, Almeida JR, Sanches LC, Pierini L, Cunha M, Sousa MT, Azevedo B, Dal-Pizzol F, Damasio DC, Bainy MP, Beduhn DAV, Jatoba JDVN, Moura MTF, Rego LRM, Silva AVD, Oliveira LP, Sodre Filho ES, Santos SSD, Neves IL, Leao VCA, Paes JLL, Silva MCM, Oliveira CD, Santiago RCB, Paranhos JLDR, Wiermann IGDS, Pedroso DFF, Sawada PY, Prestes RM, Nascimento GC, Grion CMC, Carrilho CMDM, Dantas RLAM, Silva EP, Silva ACD, Oliveira SMB, Golin NA, Tregnago R, Lima VP, Silva KGND, Boschi E, Buffon V, Machado AS, Capeletti L, Foernges RB, Carvalho AS, Oliveira Junior LC, Oliveira DC, Silva EM, Ribeiro J, Pereira FC, Salgado FB, Deutschendorf C, Silva CFD, Gobatto ALN, Oliveira CB, Dracoulakis MDA, Alvaia NOS, Souza RM, Araujo LLC, Melo RMV, Passos LCS, Vidal CFL, Rodrigues FLA, Kurtz P, Shinotsuka CR, Tavares MB, Santana IDV, Gavinho LMDS, Nascimento AB, Pereira AJ, Cavalcanti AB. IMPACTO-MR: a Brazilian nationwide platform study to assess infections and multidrug resistance in intensive care units. Rev Bras Ter Intensiva. 2022 Oct-Dec;34(4):418-425. doi: 10.5935/0103-507X.20220209-pt. Epub 2023 Mar 3.

    PubMed 36888821

Questions about this trial

What is this clinical trial studying?

A study testing Clinical observation without antibiotic therapy for VAT and 7 day antibiotic course for VAT in people with Ventilator Associated Tracheobronchitis and Tracheobronchitis, run by Hospital Sirio-Libanes at 16 sites in Brazil.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 10 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 27 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 16 sites in Brazil. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Ventilator free days (time frame: 28 days after randomization). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05266066, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Jul 2026.

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