Ventilator-associated pneumonia in trauma patients with open tracheotomy: Predictive factors and prognosis impact

Abstract

Objective:To assess the predictive factors of ventilator associated pneumonia (VAP) occurrence following open tracheotomy in trauma patients.Materials and Methods:We conducted an observational, prospective study over 15 months, between 01/08/2010 and 30/11/2011. All trauma patients (except those with cervical spine trauma), older than 15 years, undergoing open tracheotomy during their ICU stay were included. All episode of VAP following tracheotomy were recorded. Predictive factor of VAP onset were studied.Results:We included 106 patients. Mean age was 37.9 ± 15.5 years. Mean Glasgow coma Scale (GCS) was 8.5 ± 3.7 and mean Injury Severity Score (ISS) was 53.1 ± 23.8. Tracheotomy was performed for 53 patients (50%) because of prolonged ventilation whereas 83 patients (78.3%) had tracheotomy because of projected long mechanical ventilation. Tracheotomy was performed within 8.6 ± 5.3 days. Immediate complications were bleeding events (22.6%) and barotrauma (0.9%). Late complications were stomal infection (28.3%) and VAP (52.8%). In multivariate analysis, independent factors predicting VAP onset were delayed tracheotomy (OR = 0.041; CI95% [1.02-7.87]; P = 0.041) and stomal infection (OR = 3.04; CI95% [1.02-9.93]; P = 0.045). Thirty three patients died in ICU (31.1%) without significant impact of VAP on mortality.Conclusion:Late tracheotomy and stomal infection are independent factors predicting VAP onset after open tracheotomy in trauma patients. The occurrence of VAP prolongers mechanical ventilation duration and intensive care unit (ICU) length of stay (LOS) but doesn’t increase mortality.

Incidence of ventilator associated pneumonia in tracheostomised and non tracheostomised patients

“…In our study majority of the patients (54.76%) underwent tracheostomy within 7 to 10 days of mechanical ventilation which was similar to the studies done by Chaari et al and Huang et al 12,13 In our study, the total incidence of VAP was 44%. In our study out of the 42 patients who had undergone tracheostomy 13 (30.95%) patients had ventilator associated pneumonia which was similar to the study done by Chaari et al 12 Among the non tracheostomised patients 31 (53.44%) out of 58 patients developed ventilator associated pneumonia. This shows that the incidence of ventilator associated pneumonia was much higher among non tracheostomised patients compared to patients who underwent tracheostomy in the present study.…”

Incidence, Etiology and Outcome of Ventilator-Associated Pneumonia in Patients with Percutaneous Tracheotomy

“…It is a relatively low percentage as compared to the results of other studies 8,[13][14][15][16][17] , but the number of percutaneous tracheotomies performed at our ICU has been constantly increasing (from 32 in 2010 to 54 in 2012).…”

Ventilator-associated pneumonia: present understanding and ongoing debates

“…She was initially treated with tigecycline in view of beta-lactam allergy but had clinical and radiographic deterioration (b). Antibiotics were changed to intravenous aztreonam and inhaled tobramycin with clinical and radiographic improvement factors predicting VAP onset, and patients with VAP had prolonged mechanical ventilation and ICU stay, but not an increased overall mortality [78]. Parks et al in a study of 1,028 VAP episodes in trauma patients noted that using CPIS scores would have resulted in unnecessary antibiotic continuation in 59 %.…”