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Ventilator-associated pneumonia in trauma patients with open tracheotomy: Predictive factors and prognosis impact
Anis Chaari1, Hichem Kssibi, Wassim Zribi
1Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.
Insights
Delayed tracheotomy and stomal infection are key predictors of ventilator-associated pneumonia (VAP) in trauma patients. These factors increase VAP risk but do not significantly impact mortality rates.
Area of Science:
- Critical Care Medicine
- Trauma Surgery
- Infectious Diseases
Background:
- Ventilator-associated pneumonia (VAP) is a significant concern in trauma patients requiring mechanical ventilation.
- Open tracheotomy is a common procedure in this population, but carries risks of complications, including VAP.
Purpose of the Study:
- To identify predictive factors for the occurrence of VAP following open tracheotomy in trauma patients.
- To analyze the relationship between tracheotomy timing, stomal infection, and VAP development.
Main Methods:
- An observational, prospective study was conducted over 15 months.
- 106 trauma patients (excluding cervical spine trauma) over 15 years old undergoing open tracheotomy were included.
- Predictive factors for VAP onset were analyzed using multivariate analysis.
Main Results:
- The incidence of VAP was 52.8% and stomal infection was 28.3%.
- Delayed tracheotomy (OR = 0.041) and stomal infection (OR = 3.04) were identified as independent predictors of VAP onset.
- While VAP prolonged mechanical ventilation and ICU length of stay, it did not significantly impact mortality.
Conclusions:
- Late tracheotomy and stomal infection are significant independent predictors of VAP following open tracheotomy in trauma patients.
- VAP occurrence is associated with increased ventilation duration and ICU length of stay.
- VAP did not demonstrate a significant impact on overall mortality in this trauma cohort.
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.
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