Tracheostomy in Ventilator-associated Pneumonia

Abstract

Tracheostomy is considered as a strategy that may improve respiratory mechanics and patient comfort and help in the management of secretions and weaning. Tracheostomy has also been suggested as a measure to decrease the risk of development of ventilator-associated pneumonia (VAP), compared with translaryngeal intubation. However, it has not been established whether tracheostomy is an effective strategy for VAP prevention. Data from observational and randomized trials found conflicting results on the relationship between tracheostomy and VAP. A recent large randomized, multicenter, well-designed and conducted study failed to demonstrate a significant reduction in VAP rate in patients who received early compared with late tracheostomy. Physicians' attitudes regarding tracheostomy may be heterogeneous across different intensive care units and the decision to perform tracheostomy is still challenging. In the present article, we therefore aimed to determine the relationship between VAP and tracheostomy, and whether available data suggest that tracheostomy can prevent the occurrence of VAP.

Association between tracheostomy timing and mechanically ventilated patient outcomes in intensive care unit Dr. M. Djamil Hospital Padang

“…The increased risk of respiratory disorders in patients with neurological diseases can occur due to damage to the respiratory center in the medulla, posterior cranial nerves which play a role in airway protection, and the reticular activation pathway which affects consciousness through reducing the secondary reflex of airway protection. Therefore, optimizing airway management is essential to improve clinical outcomes in neurological diseases [26] . Based on comorbidities, patients in the early tracheostomy group most often had a history of respiratory disease (43.2%), followed by a history of AKI/CKD (29.7%) and other comorbidities, such as shock, electrolyte imbalance, anemia, and trauma (29.7%).…”

“…Several studies show a relationship between sedation and VAP. Sedation could lead to micro aspiration, impaired gastrointestinal motility and microcirculatory effects can favor infection in patients [26] . This study has several limitations.…”

Η Επίδραση Της Εμφύσησης Οξυγόνου Στον Αερισμό Τραχειοστομημένων Ασθενών Της ΜΕΘ Κατά Την Αποδέσμευση Από Τον Αναπνευτήρα

“…69 διασωλήνωση. Ωστόσο, δεν έχει διαπιστωθεί κατά πόσον η τραχειοστομία είναι μια αποτελεσματική στρατηγική για την πρόληψη της VAP, καθώς επίσης θα πρέπει να σημειωθεί ότι δεδομένα από παρατηρήσεις και τυχαιοποιημένες μελέτες κατέληξαν σε αντικρουόμενα αποτελέσματα153 . Σε κάθε περίπτωση όμως η μακρά παραμονή στον μηχανικό αερισμό είναι προδιαθεσικός παράγοντας για την ανάπτυξη VAP είτε πρόκειται για ενδοτραχειακό σωλήνα είτε για τραχειοστόμιο154,155 .…”