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NEW YORK (Reuters Health) Sept 03 - In patients on a ventilator for longer than 1 week, creation of a tracheotomy may reduce the risk of ventilator-associated pneumonia (VAP) and shorten the time required for mechanical ventilation, according to a report in the European Respiratory Journal for August.

VAP is a major cause of morbidity and mortality in the intensive care setting. Some studies have suggested that tracheotomy may actually raise the risk of VAP, but it is possible that the procedure simply represents a marker for longer duration of mechanical ventilation and, therefore, is not a risk factor per se.

The current findings are based on a case-control study of 177 patients who underwent tracheotomy and 177 matched subjects who did not. Standard clinical, radiographic, and microbiologic criteria were used to diagnose VAP.

The VAP rate in the tracheotomy group was 14 episodes per 1000 ventilator days, significantly lower than the 22 episode per 1000 ventilator days noted in the control group, lead author Dr. S. Nseir, from Calmette Hospital in Lille, France, and colleagues note.

On multivariate analysis, neurologic failure and antibiotic treatment were associated with 2.7- and 2.1-fold increased risks of VAP, respectively. By contrast, tracheotomy was tied to an 82% reduced risk of VAP.

"Early tracheotomy is associated with shorter duration of mechanical ventilation and stay in an intensive care unit, and lower rates of ventilator-associated pneumonia and mortality as compared with late tracheotomy," Dr. Nseir and associates conclude.

Data from randomized trials are needed to confirm these findings, they add.

Eur Respir J 2007;30:314-320.

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