Relationship between tracheotomy and ventilator-associated pneumonia: a case-control study

¹ Intensive Care Unit, Calmette Hospital, University Hospital of Lille, boulevard du Pr Leclercq, 59037 Lille cedex, France; and Medical Assessment Laboratory, EA 3614, Lille II University, 1 place de Verdun, 59045 Lille, France
² Medical Assessment Laboratory, EA 3614, Lille II University, 1 place de Verdun, 59045 Lille, France
³ Intensive Care Unit, Calmette Hospital, University Hospital of Lille, boulevard du Pr Leclercq, 59037 Lille cedex, France

^* To whom correspondence should be addressed. E-mail: s-nseir{at}chru-lille.fr.

	Abstract

To determine the relationship between tracheotomy and ventilator-associated pneumonia (VAP).

Retrospective case-control study based on prospectively data. All non-trauma immunocompetent patients, intubated and ventilated >7d, were eligible. VAP diagnosis was based on clinical, radiographic, and microbiologic criteria. 4 matching criteria were used, including duration of mechanical ventilation (MV). Indication and timing of tracheotomy were at the discretion of attending physicians. Univariate and multivariate analyses were performed to determine risk factors for VAP in cases (patients with tracheotomy) and controls (patients without tracheotomy).

1402 patients were eligible. Surgical tracheotomy was performed in 226 (16%) patients, matching was successful for 177 (78%) of them. VAP rate (22 vs. 14 VAP episodes/1000 MV-days, p=.009) was significantly higher in controls than in cases. Rate of VAP after tracheotomy in cases, or after the corresponding day of MV in controls, was also significantly higher in control than in case patients (9.2 vs. 4.8 VAP episodes/1000 MV-days, p=.005). In multivariate analysis, neurologic failure (OR [95% CI]=2.7 [1.3-5], p=.004), antibiotic treatment (OR [95% CI]=2.1 [1.1-3.2], p=.003), and tracheotomy (OR [95% CI]=.18 [0.1-0.3], p<.001) were associated with VAP.

Tracheotomy is independently associated with decreased risk for VAP.

This article has been cited by other articles:

				P. Frost and M. P. Wise Tracheotomy and ventilator-associated pneumonia: the importance of oral care Eur. Respir. J., January 1, 2008; 31(1): 221 - 221. [Full Text] [PDF]

				S. Nseir From the authors Eur. Respir. J., January 1, 2008; 31(1): 221 - 222. [Full Text] [PDF]