Nosocomial pneumonia in ICU patients after surgical and percutaneous tracheostomy
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KeywordsPublic Health Clinical Trial Mortality Rate Pneumonia Emergency Medicine
The aim of this clinical trial was to study the incidence of nosocomial pneumonia (NP) in ICU patients after surgical (SGT) and percutaneous (PCT) tracheostomy.
We studied retrospectively 108 patients, 79 men and 29 women, who underwent tracheostomy. Mean age: 52.4 ± 21.4 years, mean stay in ICU: 27.9 ± 11.6 days. All patients were mechanically ventilated. Underlying diseases: multiple trauma 69 patients, complicated surgery 23 patients, other 16 patients. Timing of procedure was determined by the ICU doctors, while the method of tracheostomy was determined by both the ICU and the Ear Nose and Throat (ENT) doctors. The patients were divided into two groups: group A (60 patients) who had a PCT and group B (48 patients) who had a SGT. The mean time of hospitalisation from admission to tracheostomy was 10.2 ± 3.1 days. PCT were performed by ICU doctors at the bedside, while SGT were performed by ENT doctors (32 at bedside and 16 in the surgery room-theater).
In group A NP was diagnosed in 23 patients (38.3%), mean time to tracheostomy from infection: 4.1 ± 2.1 days. In group B NP was diagnosed in 18 patients (37.5%), 3.5 ± 2.4 days after tracheostomy. The types of invading microorganisms were similar in both groups. The mortality rate in group A was 20/60 = 33.3% and in group B was 18/48 = 37.5%. We noticed one tracheal infection in group A (1.7%) and three in group B (6.2%); this difference was not statistically significant.
There is no significant difference in incidence of NP between patients receiving PCT and SGT. The type of infection and pathogens are similar. Tracheal infections are very rare in both groups.