Povezanost perkutane traheotomije i ventilacijske pneumonije [Correlation between percutaneous tracheotomy and ventilator-associated pneumonia]

Ventilator-associated pneumonia (VAP) is the most common infection in many Intensive Care Units, but despite enormous amount of studies there are still many uncertainties about definition, diagnosis, risk factors, treatment and prevention of VAP. Tracheotomy has been suggested as a risk factor favouring VAP onset, but only a few studies have specified the time elapsed between tracheotomy and VAP onset. The main aim of the present study was to evaluate if the tracheotomy is really risk factor for VAP development and its impact on VAP clinical course (duration of mechanical ventilation, length of ICU stay, mortality). A secondary aims were to determine the incidence and etiology of VAP among percutaneous tracheotomised patients. In addition, secondary aim was also to examine the potential benefits of early tracheotomy on clinical course of VAP. The study was conducted in a 15-bed surgical and neurosurgical Intensive Care Unit of the Department of Anaesthesiology and Intensive Care of the University Hospital Centre „Sestre Milosrdnice“, Zagreb, Croatia. The retrospective data were collected from September 2009 to March 2013. All patients developing VAP during the ICU stay were eligible for the study. The main study group were percutaneous tracheotomised patients. According to our data, incidence of VAP among percutaneous tracheotomised patients was statistical significant smaller than in all others patients mechanical ventilated more than 48 hours (8,5% vs 24,9%, P<0,001). Most of VAP cases (80%) among percutaneous tracheotomised patients occur before tracheotomy. Duration of mechanical ventilation is only risk factors for VAP development after perfoming percutaneous tracheotomy. In VAP patients not tracheotomised during the ICU stay, the mortality rate was approximately two times higher as compared to the patients tracheotomised either before or after the VAP onset. The total duration of mechanical ventilation, as well as the length of ICU, were the same among not tracheotomised patients as compared to tracheotomised patients. In VAP patients surgical tracheotomised during the ICU stay, the duration of mechanical ventilation and length of ICU stay were longer as compared to the patients percutaneous tracheotomised. The present study indicates that an early tracheotomy is associated with a reduced duration of mechanical ventilation and the reduced length of stay in Intensive Care Unit, but is unable to reduce frequency of ventilator-associated pneumonia and mortality. In summary, the present study indicates that a percutaneous tracheotomy has positive impact on VAP clinical course.