Tracheotomy Reduces The Risk Of Ventilator-Associated Pneumonia

Main Category: Respiratory / Asthma
Article Date: 26 Jul 2007 - 15:00 PDT

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Ventilator-associated pneumonia (VAP) is frequent in patients undergoing mechanical ventilation and is associated with substantial morbidity and mortality. 10% of intensive care unit (ICU) patients receive invasive mechanical ventilation through a tracheotomy cannula during their ICU stay.

Several recent studies identified tracheotomy as a risk factor for VAP. However, none of them has taken into account the duration of mechanical ventilation, which is a major risk factor for this complication. Moreover, based on the pathophysiology of VAP, tracheotomy could be protective against this nosocomial infection. Therefore, Saad Nseir (Calmette Hospital, Lille, France) and his colleagues performed this study to determine the relationship between VAP and tracheotomy.

This retrospective case-control study is based on prospective data. Patients with tracheotomy (cases) were matched with patients without tracheotomy (controls), according to four criteria, including duration of mechanical ventilation. In total, 1,402 patients were eligible. Surgical tracheotomy was performed in 226 (16%) and matching was successful for 177 (78%).

VAP rate was significantly higher in controls than in case patients: 22 episodes per 1,000 mechanical ventilation-days versus 14.
The protective role of tracheotomy against VAP could be explained by two mechanisms: a reduction of aspiration of secretions from the oropharyngeal cavity, and a reduction of biofilm formation, since tracheotomy cannula was changed twice a week. Aspiration of oropharyngeal secretions and biofilm formation are two factors known to be important for the development of VAP.

The authors conclude that tracheotomy is associated with decreased risk of VAP in ICU patients.

European Respiratory Journal

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