Abstract
The aim of the study. The primary objec-tive of this study was to determine the differences in the incidence of respiratory infections and septic episodes in patients who underwent early percutaneous trache-otomy (ET) and in patients who underwent translaryngeal intubation i.e late trache-otomy (LT). Secondary objectives were to determine the differences in the early mortality of patients, duration of mechani-cal ventilation and length of Intensive care unit (ICU) stay.Materials and methods. The study included 72 surgical and trauma patients older than 18 years of age, treated at the ICU of the University Clinical Hospital Mostar who had undergone translaryngeal intubation and were mechanically ventilated for at least 48 hours. The basic criterion for inclu-sion in the study was expected duration of mechanical ventilation of at least 14 days. Forty-eight hours after enrollment, patients were randomly divided into two groups. The first group of patients underwent ET after 2-4 days of mechanical ventilation; the second group underwent LT if they ex-hibited longer episodes of hypoxemia after 15 days. Results. The ET group of patients spent less time in mechanical ventilation and ICU. The ET group had a lower rate of VAS pneumonia (p=0.137), sepsis episodes (p=0.029) and mortality rate (p=0.056). Conclusion. The results of our study sup-port ET being performed 2–4 days from the start of mechanical ventilation. De-spite a lack of power, we found significant benefits of ET regarding the incidence of pneumonia, sepsis, hospital mortality, du-ration of mechanical ventilation and length of ICU stay
Highlights
Ventilator associated pneumonia (VAP) was diagnosed based on standardized criteria: body temperature 36, purulent bronchial secretions, new lung infiltrate observed on X-ray, qualitative and quantitative microbiological analysis of the bronchial secretion obtained by bronchoalveolar lavage and laboratory diagnostics
The difference found in the incidence of pneumonia among patients from the observed groups is not statistically significant (p=0.128), but patients who underwent late tracheotomy (LT) were found to be more likely to develop pneumonia than those who underwent early percutaneous tracheotomy (ET) (OR=2.000; 95% CI: 0.816-4.902)
Sepsis is more likely to occur in patients who had LT than in patients who had ET (OR=2.479; 95% CI: 0.995-6.176)
Summary
The optimal method of treating the airways and implementing the process of mechanical ventilation in patients who are unable to breathe spontaneously, has been the object of clinicians’ interest for almost a hundred years. [1] In comparison with translaryngeal intubation, the benefits of early percutaneous tracheotomy (ET) include: prevention of serious injury to the larynx, greater airway safety, decreased airway resistance, facilitated pulmonary hygiene, and oral cavity care which can reduce the incidence of developing lung infections, help to facilitate the weaning process of mechanical ventilation, and greater mobility and comfort of patients. [2] the rate of tracheotomy procedures, in particular percutaneous tracheotomy, has, according to the literature, increased by 200% in recent years, the analysis of major databases still continues to show an unbalanced approach in regards to the time required to perform tracheotomy procedures, early or late, and the conflicting and inconsistent results relating to the incidence of nosocomial infection, cardiac complications, duration of treatment, duration of mechanical ventilation, and survival rate of patients. [3] Adesina et al point out the reduced number of days on the ventilator and shorter treatment in the Intensive care unit (ICU) as benefits of ET; their study did not report a decrease in hospital mortality rate. [4] Shorter treatment in ICUs is cited in other studies as well, [5,6,7] while Mahafza et al and Rumbak et al reported a decrease in mortality rate as a benefit of ET too. [8,9] In a study by Brook et al, the reduction of hospital costs is cited to be one of the benefits, which is not to be disregarded. [10] The majority of previous studies is retrospective, time spent performing ET in the cited studies was too big (two to ten days), while non-homogeneous groups of patients made it difficult to interpret the results. [2] the rate of tracheotomy procedures, in particular percutaneous tracheotomy, has, according to the literature, increased by 200% in recent years, the analysis of major databases still continues to show an unbalanced approach in regards to the time required to perform tracheotomy procedures, early or late, and the conflicting and inconsistent results relating to the incidence of nosocomial infection, cardiac complications, duration of treatment, duration of mechanical ventilation, and survival rate of patients. [3] Adesina et al point out the reduced number of days on the ventilator and shorter treatment in the Intensive care unit (ICU) as benefits of ET; their study did not report a decrease in hospital mortality rate. Secondary objectives were to determine the differences in early mortality of patients, duration of mechanical ventilation and length of ICU stay
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
