Impact of early tracheotomy on ventilator-associated pneumonia in critical illness.

OBJECTIVE To evaluate whether early tracheotomy(ET) can decrease the morbidity of ventilator-associated pneumomia(VAP) in critically ill patients.METHODS A retrospective cohort study was performed,tracheotomy patients data of baseline characteristics,diagnosis,duration of mechanical ventilation,ICU length of stay,incidence of VAP,mortality,as well as the dosage of analgesics and sedatives were collected from the past thirty-nine months.From Jan 2008 to Jun 2009,patients who were expected to be ventilated over seven days were performed early tracheotomy within 72 hours intubation.The historical control group from Mar 2006 to Dec 2009,which included the patients with continuous mechanical ventilation,undertook tracheostomy more than seven days after intubation.RESULTS Baseline patients characteristics were similar in two cohorts.Duration of mechanical ventilation and length of ICU stay of ET group were significantly shorter than those of control group(24±24.76d vs 36.57±26.23 d,P=0.023,and 31.05±26.71d vs 43.45±30.81 d,P=0.047).ET group had a lower incidence rate of VAP than control group,but there was no significant difference of mortality between two groups.ET group had a less dosage of fentanyl and midazolam than control group(2.47±1.77mg vs 3.44±2.23mg,P=0.026,and 228.77±160.35mg vs 413.52±260.12mg,P0.001),but there was no statistical difference in propofol dosage between the two groups.CONCLUSION Early tracheotomy can shorten the duration of mechanical ventilation and ICU length of stay,decrease incidence rate of VAP and dosage of analgesics and sedatives,but can't lower the mortality.