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Clinical Investigations in Critical CareIncidence, Etiology, and Outcome of Nosocomial Pneumonia in ICU Patients Requiring Percutaneous Tracheotomy for Mechanical Ventilation
Section snippets
Study Population
The study was conducted in a 14-bed medical-surgical ICU at a teaching hospital from January 2000 until June 2002. All patients who required tracheotomy during the ICU stay were eligible for study. Patients were excluded if the tracheotomy was performed prior to ICU admission. Surgical tracheotomies were performed by an otorhinolaryngologic surgical specialist in the operating room, and these patients were also excluded. Percutaneous tracheotomies were performed by the ICU staff (C.B., M.B.,
Results
A total of 796 consecutive patients received intubation and mechanical ventilation over the study period, representing 6,833 ventilation-days. One hundred ten of these patients (13.8%) underwent tracheotomies. Eleven patients underwent a surgical tracheotomy in the operating room due to existence of contraindications for percutaneous tracheotomy: morbid obesity (n = 4), unstable cervical fracture n = 3), uncertainty in identifying the anatomic landmarks (n = 3), and emergency surgical airway
Discussion
This study investigated the epidemiology of pneumonia and other infectious complications in patients receiving short-term mechanical ventilation requiring tracheotomy in the ICU. In contrast with intubated patients, this subset of patients has been investigated rarely in the literature.10 A unique aspect of this study is that all patients underwent percutaneous tracheotomy. Our findings suggest that the risk of transient bacteremia or wound infections is marginal. The risk of pneumonia was
ACKNOWLEDGMENT
We wish to thank Marta Roque for statistical support, Carmen Ardanuy for microbiologic support, and Michael Maudsley for editing the manuscript.
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Supported in part with grants from Comissio Interdepartmental Recerca i Technologica (SGR2001-414) and Distincio a la Promocio de la Recerca Universitaria (Dr. Rello).