scholarly journals Role of early tracheostomy for preventing ventilator associated pneumonia in intensive care unit: a review

2021 ◽  
Vol 7 (6) ◽  
pp. 1083
Author(s):  
Santosh Kumar Swain ◽  
Pragnya Paramita Jena
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Mechanics ◽  
Review Article ◽  
Patient Comfort ◽  
Ventilator Associated Pneumonia ◽  
Early Group ◽  
Fatal Complication ◽  
Early Tracheostomy ◽  
Critical Unit

<p class="abstract">Tracheostomy often plays a crucial role in airway management of the patients in intensive critical unit (ICU). Tracheostomy is often helpful for improvement of the respiratory mechanics and the patient comfort. There are several advantages of the trachesotomy over the endotracheal tube intubation such as avoidance of the injury of the larynx, provide a stable airway, facilitates pulmonary toilet and facilitates ventilation. It has been suggested that tracheostomy also helpful to reduce the risk of ventilator associated pneumonia (VAP) in comparison to the trans-laryngeal intubation. VAP is a type of nosocomial infection which has been associated with presence of mechanical ventilation. Despite significant improvement in managing the intubated patients, VAP remains a common and sometimes fatal complication in the ICU. Clinician’s attitude towards trachesotomy may be still heterogeneous in ICU and the decision for performing tracheostomy is still challenging. However, early tracheostomy is associated with less VAP, less ICU stay, avoid higher number of intubation in early group of tracheostomy and higher patient comfort. The purpose of this review article was to discuss the etiopathology of VAP, epidemiology, role of early tracheostomy in VAP and prevention of the VAP in patients with mechanical ventilation in ICU.</p>

scholarly journals Incidence of ventilator associated pneumonia in tracheostomised and non tracheostomised patients

2018 ◽  
Vol 6 (8) ◽  
pp. 2754
Author(s):  
David D. M. Rosario ◽  
Anitha Sequeira
Keyword(s):  
Mechanical Ventilation ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Early Tracheostomy ◽  
Hospital Acquired Infection ◽  
Total Incidence ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Background: Pneumonia is the most common hospital acquired infection in the intensive care unit. One of the causes for hospital acquired pneumonia is ventilator associated pneumonia. Tracheostomy is known to prevent occurrence of ventilator associated pneumonia as it decreases the respiratory dead space, assists in better clearance of secretions and prevents chances of aspiration. Generally, tracheostomy is done after 2 weeks of endotracheal intubation to prevent tracheal complications. The aim of this study is to identify the incidence of ventilator associated pneumonia in tracheostomised and non tracheostomised patients and to see if early tracheostomy can prevent development of ventilator associated pneumonia.Methods: The study was conducted at a tertiary care hospital during a period of four years. 100 patients who were on mechanical ventilation for more than 7 days where taken up for the study. APACHE 4 scoring system was used. The incidence of Ventilator associated pneumonia in tracheostomised and non tracheostomised patients was studied.Results: In our study the total incidence of VAP was 44 %. In our study out of the 42 patients who had undergone tracheostomy 13 (30.95%) patients had ventilator associated pneumonia. Among the non-tracheostomised patients 31 (53.44%) out of 58 patients developed ventilator associated pneumonia. In our study the incidence of ventilator associated pneumonia was much lesser (12%) in patients who underwent tracheostomy in the period 7 to 10 days after mechanical ventilation, whereas in those who underwent tracheostomy after 11 days incidence of ventilator associated pneumonia was much higher.Conclusions: Our study showed that the incidence of ventilator associated pneumonia was much higher among non tracheostomised patients compared to patients who underwent tracheostomy. Hence patients undergoing earlier tracheostomy had a clear advantage than those undergoing tracheostomy late or non tracheostomised patients in preventing ventilator associated pneumonia.

511 A Retrospective Review of the Timing of Tracheostomy in Mechanically Ventilated Patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S102-S103
Author(s):  
Kevin N Foster ◽  
Juzer R Munaim ◽  
Biomedical Engineering ◽  
Claudia Islas ◽  
Suzanne C Osborn ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Endotracheal Intubation ◽  
Prolonged Mechanical Ventilation ◽  
Care Facility ◽  
Hospital Length ◽  
Inhalation Injury ◽  
Hospital Length Of Stay ◽  
Patient Comfort ◽  
Early Tracheostomy ◽  
Improved Outcomes

Abstract Introduction Tracheostomy is indicated for prolonged mechanical ventilation. Tracheostomy provides various benefits over prolonged endotracheal intubation including improved airway care, diminished need for sedation, reduced airway resistance, and increased patient comfort. However, the timing and effectiveness of tracheostomies has been controversial. Several studies, have indicated that early tracheostomy reduces the length of ICU and hospital stay, decrease the time on mechanical ventilation, and reduces the incidence of nosocomial pneumonia. In contrast other studies have shown that early tracheostomy shows no benefit, or even extends the length of mechanical ventilation in some patients. The purpose of this study was to evaluate the timing and the appropriateness of timing of tracheostomy. Methods This was a retrospective study of burn patients requiring mechanical ventilation over a 5-year period. The main comparison groups were endotracheal tube only (ETT) vs tracheostomy (Trach) and early tracheostomy (ETrach) vs. late tracheostomy (LTrach). Tracheostomies that were performed within the first 7 days were considered to be ETrach. Results Age, gender, ethnicity, % TBSA burned, presence of inhalation injury did not differ between any of the groups. The Trach group demonstrated increased hospital length of stay (LOS) (22 vs. 39 days, p&lt; .0001), greater number of ICU days (11 vs. 31 days, p&lt; .0001), greater number of surgeries (3.7 vs. 6.6, p&lt; .0001) and patients in this group were more likely to be discharged to a post-acute care facility rather than home, when compared to the ETT group (p&lt; .0001). The Trach group also was more likely to develop ventilator-associated pneumonia (VAP) (23% vs. 48%, p&lt; .0001), and more likely to develop swallowing abnormalities. Similarly, the LTrach group demonstrated greater number of ICU days (25 vs. 32 days, p=.04), greater number of ventilator days (23 vs. 29 days, p=.03), greater number of surgeries (4.5 vs 7.2, p=.02), but fewer days to liberate from the ventilator (19.4 vs 13.6 days, p=.04). This group also was more likely to develop VAP than the ETrach group (28% vs 53%, p=.03). Conclusions This study demonstrates a number of improved outcomes of tracheostomy over continued endotracheal intubation, and a number of improved outcomes of early tracheostomy over later tracheostomy. The most significant improved outcomes were decreased incidence of VAP and decreased swallowing difficulties following extubation/decannulation.

VENTILATOR ASSOCIATED PNEUMONIA-REVIEW ARTICLE

2021 ◽  
pp. 64-65
Author(s):  
Bharti Choudhary ◽  
Nishchint Sharma
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Review Article ◽  
Evidence Based ◽  
Ventilator Associated Pneumonia ◽  
Evidence Based Practices ◽  
Prolonged Duration ◽  
Vap Bundle

Ventilator-associated pneumonia (VAP) is one of the most frequent ICU-acquired infections and a leading cause of death among patients in Intensive Care Unit (ICU). VAP is associated with prolonged duration of mechanical ventilation and ICU stay. The estimated mortality of VAP is around 10%. There are many risk factors including host related, device related and personnel related. For prevention of VAP it is recommended to minimize the exposure to mechanical ventilation and encouraging early liberation. VAP bundle as a group of evidence-based practices that, results in decrease in the incidence of VAP should be used. Patients should be reassessed daily to conrm ongoing suspicion of disease, antibiotics should be guided by cultures reports, and clinicians should consider stopping antibiotics if cultures are 1 negative.

scholarly journals Early Tracheostomy for ARDS Patients Supported by Venovenous Extracorporeal Membrane Oxygenation Is Associated With A Decreased Incidence of Ventilator-Associated Pneumonia, Duration of Extracorporeal Membrane Oxygenation and Mechanical Ventilation: Experience From A Single-Center Retrospective Cohort.

2021 ◽  
Author(s):  
Zeyu Zhang ◽  
Sichao Gu ◽  
Xu Huang ◽  
Jingen Xia ◽  
Fang Lin ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Mortality Rate ◽  
Extracorporeal Membrane Oxygenation ◽  
Retrospective Cohort ◽  
Ecmo Support ◽  
Ventilator Associated Pneumonia ◽  
Icu Mortality ◽  
Early Tracheostomy ◽  
Membrane Oxygenation ◽  
Venovenous Extracorporeal Membrane Oxygenation

Abstract Background: Venovenous extracorporeal membrane oxygenation (ECMO) has become the ultimate supporting technique for the rescue of severe acute respiratory distress syndrome (ARDS) patients. Although tracheostomy during ECMO has proven to be beneficial, the proper time point for performing the tracheostomy remains unclear. The purpose of our study was to demonstrate whether early tracheostomy (ET; within 7 days of ECMO initiation) outweighs delayed tracheostomy (DT; 8 days of more after ECMO initiation).Methods: A retrospective cohort study was established. All ARDS patients who underwent tracheostomy during V-V ECMO support in the intensive care unit (ICU) of a tertiary hospital from December 2013 to November 2020 were reviewed.Results: Of the 187 ARDS patients who received V-V ECMO support, 30 (16%) underwent tracheostomy—18 (60%) during ECMO support and the other 12 after ECMO decannulation. Among the 18 patients who underwent tracheostomy while receiving ECMO, 11 (61.1%) received ET, and 7 received DT. No significant difference was found between the ET and DT groups in terms of demographic data, medical history, disease severity (estimated based on the RESP, PRESERVE, APACHE Ⅱ, SOFA and Murray scores), ARDS risk factors or mechanical ventilation duration before ECMO. The ET group showed a decreased incidence of ventilator-associated pneumonia (VAP) during ECMO support (45.5% vs. 100%; P= 0.038) and shortened durations of ECMO (9.0 vs. 27.0 days; P= 0.011) and mechanical ventilation (16.0 vs. 56.0 days; P= 0.027). ET did not significantly alter the all-cause ICU mortality rate (54.5% vs. 28.6%; P= 0.367), all-cause hospital mortality rate (which was the same as the ICU mortality rate), length of ICU stay (336 vs. 627 hours; P= 0.085), or length of hospital stay (26 vs. 37 days; P= 0.285). Local bleeding at the tracheostomy wound did not differ between the two groups (27.3% vs. 42.9%, P= 0.627) .Conclusion: Compared with delayed tracheostomy, ET performed within 7 days of ECMO cannulation for severe ARDS patients could decrease the VAP incidence during ECMO support and shorten the durations of ECMO and mechanical ventilation; However, it may not improve the outcome. Prospective and multicenter studies are needed for further research.

scholarly journals Investigating the Role of Subglottic Secretions Suctioning in the Prevention of ‎Ventilator Associated Pneumonia in Patients With Invasive Mechanical ‎Ventilation

2019 ◽  
Vol 11 (6) ◽  
pp. 111
Author(s):  
Iyad Abbas Salman ◽  
Waleed Ibraheem Ali ◽  
Amir Ibrahim Moushib ◽  
Hayder Adnan Fawzi
Keyword(s):  
Mechanical Ventilation ◽  
Endotracheal Tube ◽  
Invasive Mechanical Ventilation ◽  
Tracheal Aspirate ◽  
Ventilator Associated Pneumonia ◽  
Mechanically Ventilated ◽  
Subglottic Secretion ◽  
Radiological Features ◽  
Ventilated Patients

BACKGROUND: development of ventilator associated pneumonia (VAP) leads to &lrm;prolonged hospital stay, increased health care cost, and mortality rates. Subglottic &lrm;secretion drainage through a dedicated endotracheal tube has been advocated as a mean &lrm;to decrease the incidence of VAP and thereby assisting in &lrm;the decrease of morbidity associated with invasive mechanical ventilation.&lrm; OBJECTIVE: Investigate the role of subglottic secretion suctioning in the prevention of VAP in mechanically ventilated patients in intensive care unit.&lrm; METHODS: A cross sectional study done in the intensive care unit of Ghazi Al-Hariri &lrm;hospital for surgical specialties in medical city complex, 30 patients who &lrm;are in need for invasive mechanical ventilation were intubated with endotracheal tube &lrm;that have special port for subglottic secretion suctioning. Daily monitoring of patients &lrm;clinical and radiological data to detect features of VAP was &lrm;done, and if there was a suspicion of pneumonia, culture for tracheal aspirate performed &lrm;to confirm diagnosis.&lrm; RESULTS: &lrm;Patient&rsquo;s age was 37.1 &plusmn; &lrm;&lrm;15.39 years, the highest proportion of study patients was found in &lrm;age group &lt; 30 and &lrm;&lrm;30&ndash;49 years (40% in &lrm;each group), most of the patients were males (70%) with a male to female ratio of &lrm;&lrm;2.33:1&lrm;&rlm;, &rlm;Subglottic secretion suctioning lead to reduction in VAP by relative risk (95%CI) of &rlm;&lrm;0.167 (0.045&ndash;0.559)&lrm;&rlm;, p-&rlm;value = 0.001. &rlm;Twenty eight patients didn&rsquo;t show any sign, symptoms &lrm;or radiological features suggesting a &lrm;diagnosis of pneumonia while two patients developed &lrm;features of pneumonia (suggestive signs and &lrm;symptoms, radiological features and &lrm;positive culture of tracheal aspirate).&lrm; CONCLUSION: the use of endotracheal tube with subglottic &lrm;secretions suctioning can have a role in the prevention of VAP in mechanically ventilated patients.&lrm;

scholarly journals Role of colonizers and value of routine surveillance culture of endotracheal aspirate of patients in the diagnosis of ventilator associated pneumonia

2020 ◽  
Vol 11 (6) ◽  
pp. 106-112
Author(s):  
Sana Siddique ◽  
Fareya Haider ◽  
Sharique Ahmad ◽  
Khalid Iqbal ◽  
Mastan Singh
Keyword(s):  
Mechanical Ventilation ◽  
Pseudomonas Aeruginosa ◽  
Tertiary Care ◽  
Causative Organism ◽  
Klebsiella Pneumonia ◽  
Surveillance Culture ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Endotracheal Aspirate

Background: Ventilator associated pneumonia (VAP) is considered to be second most common nosocomial infection patients requiring critical care. Aims and Objective: The present study was conducted to study the role of colonizers and importance of surveillance cultures of endotracheal aspirate (ETA) in the diagnosis of ventilator associated pneumonia in a tertiary care hospital in Lucknow. Materials and Methods: An observational longitudinal study was conducted over a period of 2 years, on a total of 210 critically ill patients on mechanical ventilation for >48hrs, to identify the common isolates from ETA culture. Follow up of such patients was done to know the role of these isolates in causation of Ventilator Associated Pneumonia (VAP). Patients fulfilling both clinical Pulmonary infection score (CPIS>6) and microbiological criteria were diagnosed as VAP. Those microorganisms with a colony count of less<105 cfu/ml in both the patients with VAP and those without VAP were considered as colonizers. Results: Klebseilla pneumonia (46.2%), Pseudomonas aeruginosa (16.2%) and E.coli (13.8%) were found be the commonest colonisers followed by Acinetobacterbaumanii (8.6%), Citrobacterkoseri (3.8%), Coagulase Negative Staphylococci (2.9%), Staphylococcus aureus (2.4%) and Proteus vulgaris (1%). Of the total patients 28 developed VAP out of which 21 had late onset VAP and 7 had early onset VAP. Among the VAP positive patients the causative organism was Klebsiella pneumonia (53.6%) for majority of cases followed by Pseudomonas aeruginosa (21.4%) and Acinetobacter baumanii (17.9%). Conclusion: Prolonged duration of mechanical ventilation increased the chances of colonization by MDR microorganisms leading to nosocomial or Hospital acquired infections (HAI) such as VAP which in turn lead to increased rate of morbidity and mortality. VAP considered to be a leading cause of HAI, routine quantitative surveillance culture of ETA(endotracheal aspirate) will allow prospectively to determine prevalence and progression of  colonization in lower respiratory tract, so that strict and prompt preventive measures can be taken rather than cure.

scholarly journals Apneic Tracheostomy in COVID-19 Patients on Veno-Venous Extracorporeal Membrane Oxygenation

Membranes ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 502
Author(s):  
Matteo Rossetti ◽  
Chiara Vitiello ◽  
Valeria Campitelli ◽  
Raffaele Cuffaro ◽  
Claudia Bianco ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Patient Care ◽  
Respiratory Mechanics ◽  
Prolonged Mechanical Ventilation ◽  
Aerosol Particles ◽  
Respiratory Care ◽  
Huge Number ◽  
Severe Hypoxemia ◽  
Early Tracheostomy ◽  
Virus Spreading

COVID-19 creates an impressive burden for intensive care units in terms of need for advanced respiratory care, with a huge number of acute respiratory distress syndromes (ARDS) requiring prolonged mechanical ventilation. In some cases, this proves to be insufficient, with a refractory respiratory failure calling for an extracorporeal approach (veno-venous ECMO). In this scenario, most of these patients need an early tracheostomy procedure to be carried out, which creates the risk of distribution of aerosol particles, possibly leading to personnel infection. The use of apneic tracheostomy has been proposed for COVID-19 patients, but in case of ECMO it may produce lung derecruitment, severe hypoxemia, and sudden worsening of respiratory mechanics. We developed an apneic tracheostomy technique and applied it in over 32 patients supported by veno-venous ECMO. We present data showing the safety and feasibility of this technique in terms of patient care and personnel protection. Gas exchange and pH did not show statistically significant changes after the tracheostomy, nor did respiratory mechanics data or the need for inspiratory pressure and FiO2. The use of apneic tracheostomy was a safe option for patient care during ECMO and reduced the possibility of virus spreading.

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