| Abstract | Ventilacijska pneumonija (VAP) je najčešća infekcija u JIL-ovim diljem svijeta, no usprkos
brojnim istraživanjima još postoje brojne dileme u vezi njezine definicije, rizičnih čimbenika,
dijagnostike, liječenja i prevencije. Traheotomija se često spominje kao jedan od mogućih
rizičnih čimbenika za razvoj VAP-a, no kroz brojna istraživanja nije jasno naznačeno da li je
traheotomija uzrok ili posljedica VAP-a. Cilj ovog istraživanja je bio utvrditi da li je
traheotomija zaista rizični čimbenik za razvoj VAP-a i kakav utjecaj ima na klinički tijek
VAP-a (trajanje mehaničke ventilacije, duljina boravka u JIL-u, smrtnost). Sekundarni ciljevi
su bili utvrđivanje incidencije i etiologije VAP-a u traheotomiranih kirurških pacijenata, kao i
ispitivanje potencijalne koristi rane traheotomije na klinički tijek VAP-a. Istraživanje je
provedeno u 15-krevetnoj Jedinici intenzivnog liječenja Odjela za anesteziologiju,
reanimatologiju i intenzivno liječenje u Kliničkom bolničkom centru “Sestre Milosrdnice”,
Zagreb, Hrvatska. Podaci su skupljani retrospektivno od rujna 2009. do ožujka 2013. godine.
U istraživanje su uključeni svi pacijenti s VAP-om tijekom navedenog perioda. Glavna
ispitivana skupina su bili perkutano traheotomirani pacijenti. Prema našim podacima
incidencija VAP-a među perkutano traheotomiranim pacijentima je statistički značajno manja
nego incidenacija VAP-a među svim mehanički ventiliranim pacijentima duže od 48 sati
(8,5% vs 24,9%, P<0,001). Većina VAP-ova (80%) u perkutano trahetomiranih pacijenata se
javlja prije izvođenja traheotomije. Trajanje mehaničke ventilacije je jedini rizični čimbenik
povezan s nastankon VAP-a poslije izvođenja perkutane traheotomije. Smrtnost u grupi
pacijenata sa VAP-om koji nisu tijekom svojeg boravka traheotomirani je dvostruko veća od
smrtnosti perkutano traheotomiranih pacijenata, bez obzira da li se VAP javio prije ili nakon
izvođenja traheotomije. Trajanje mehaničke ventilacije i duljina boravka u JIL-u je jednaka u
netraheotomiranih i perkutano traheotomiranih, ali je u perkutano traheotomiranih statistički
značajno kraća nego u kirurški traheotomiranih pacijenata. Rana traheotomija nema utjecaja
na smrtnost i incidenciju VAP-a, no skraćuje trajanje mehaničke ventilacije i boravak u JIL-u.
U zaključku možemo reći da perkutana traheotomija ima povoljan utjecaj na klinički tijek
ventilacijske pneumonije. |
| Abstract (english) | Ventilator-associated pneumonia (VAP) is the most common infection in many Intensive Care Units, but despite enormous amount of studies there are still many uncertainties about definition, diagnosis, risk factors, treatment and prevention of VAP. Tracheotomy has been suggested as a risk factor favouring VAP onset, but only a few studies have specified the time elapsed between tracheotomy and VAP onset. The main aim of the present study was to evaluate if the tracheotomy is really risk factor for VAP development and its impact on VAP clinical course (duration of mechanical ventilation, length of ICU stay, mortality). A secondary aims were to determine the incidence and etiology of VAP among percutaneous tracheotomised patients. In addition, secondary aim was also to examine the potential benefits of early tracheotomy on clinical course of VAP. The study was conducted in a 15-bed surgical and neurosurgical Intensive Care Unit of the Department of Anaesthesiology and Intensive Care of the University Hospital Centre „Sestre Milosrdnice“, Zagreb, Croatia. The retrospective data were collected from September 2009 to March 2013. All patients developing VAP during the ICU stay were eligible for the study. The main study group were percutaneous tracheotomised patients. According to our data, incidence of VAP among percutaneous tracheotomised patients was statistical significant smaller than in all others patients mechanical ventilated more than 48 hours (8,5% vs 24,9%, P<0,001). Most of VAP cases (80%) among percutaneous tracheotomised patients occur before tracheotomy. Duration of mechanical ventilation is only risk factors for VAP development after perfoming percutaneous tracheotomy. In VAP patients not tracheotomised during the ICU stay, the mortality rate was approximately two times higher as compared to the patients tracheotomised either before or after the VAP onset. The total duration of mechanical ventilation, as well as the length of ICU, were the same among not tracheotomised patients as compared to tracheotomised patients. In VAP patients surgical tracheotomised during the ICU stay, the duration of mechanical ventilation and length of ICU stay were longer as compared to the patients percutaneous tracheotomised. The present study indicates that an early tracheotomy is
associated with a reduced duration of mechanical ventilation and the reduced length of stay in Intensive Care Unit, but is unable to reduce frequency of ventilator-associated pneumonia and mortality. In summary, the present study indicates that a percutaneous tracheotomy has positive impact on VAP clinical course. |
