title: Ventilator-associated pneumonia in trauma patients with open tracheotomy: Predictive factors and prognosis impact.
abstract: OBJECTIVE
  To assess the predictive factors of ventilator associated pneumonia (VAP) occurrence following open tracheotomy in trauma patients.
  
  
  METHODS
  We conducted an observational, prospective study over 15 months, between 01/08/2010 and 30/11/2011. All trauma patients (except those with cervical spine trauma), older than 15 years, undergoing open tracheotomy during their ICU stay were included. All episode of VAP following tracheotomy were recorded. Predictive factor of VAP onset were studied.
  
  
  RESULTS
  We included 106 patients. Mean age was 37.9 ± 15.5 years. Mean Glasgow coma Scale (GCS) was 8.5 ± 3.7 and mean Injury Severity Score (ISS) was 53.1 ± 23.8. Tracheotomy was performed for 53 patients (50%) because of prolonged ventilation whereas 83 patients (78.3%) had tracheotomy because of projected long mechanical ventilation. Tracheotomy was performed within 8.6 ± 5.3 days. Immediate complications were bleeding events (22.6%) and barotrauma (0.9%). Late complications were stomal infection (28.3%) and VAP (52.8%). In multivariate analysis, independent factors predicting VAP onset were delayed tracheotomy (OR = 0.041; CI95% [1.02-7.87]; P = 0.041) and stomal infection (OR = 3.04; CI95% [1.02-9.93]; P = 0.045). Thirty three patients died in ICU (31.1%) without significant impact of VAP on mortality.
  
  
  CONCLUSIONS
  Late tracheotomy and stomal infection are independent factors predicting VAP onset after open tracheotomy in trauma patients. The occurrence of VAP prolongers mechanical ventilation duration and intensive care unit (ICU) length of stay (LOS) but doesn't increase mortality.
authors: Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.
authors: Anis
authors: A
authors: Chaari
authors: Hichem
authors: H
authors: Kssibi
authors: Wassim
authors: W
authors: Zribi
authors: Fatma
authors: F
authors: Medhioub
authors: Hedi
authors: H
authors: Chelly
authors: Najla B
authors: NB
authors: Algia
authors: Chokri B
authors: CB
authors: Hamida
authors: Mabrouk
authors: M
authors: Bahloul
authors: Mounir
authors: M
authors: Bouaziz
keywords: Multiple trauma; prognosis; tracheotomy; ventilator associated pneumonia