Chest
Clinical InvestigationsImpact of Tracheotomy on Colonization and Infection of Lower Airways in Children Requiring Long-term Ventilation: A Prospective Observational Cohort Study
Section snippets
Materials and Methods
This investigation was a 2½ year prospective observational cohort study from September 1, 1993, until February 28, 1996, in children requiring long-term mechanical ventilation, initially transtracheally and subsequently via tracheotomy, in the PICU.
Results
Before the tracheotomy, all patients had been intubated with orotracheal or nasotracheal tubes, and mechanically ventilated for a median of 22.5 days (range, 1 to 50 days; 95% CI, 7 to 31 days) (Table 1). Following tracheotomy, mechanical ventilation continued for a median of 16.5 days (range, 1 to 220 days; 95% CI, 2 to 45 days). Mechanical ventilation was expected to be permanent in two patients (patients 18 and 20 in Table 2). In four of the patients (patients 3, 13, 15, and 22), infection
Discussion
The significant increase in colonization rates from 7 to 35% once the children received a tracheotomy is thought to be due to altered anatomy (including the presence of a skin lesion), positional change of the trachea, exposure of the tracheal mucosa to the atmosphere, mucous stasis, a change in pH of the mucus,17 the presence of a foreign body (the tracheotomy tube), and repeated manipulation of the trachea during suctioning.
Although the colonization rate of the lower airway approached 100%,
Acknowledgments
We are very grateful to the medical and nursing staff of the PICU and to the microbiology department for their cooperation, to Nia Catahan for her skillful preparation of the tables and figures, and to Mr. J. Rogers and Dr. M.S. Niederman for carefully reviewing the manuscript.
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