The effect of tracheotomy on ventilator-associated pneumonia rate in children

Early versus late tracheostomy in stroke-related patients: A systematic review and meta-analysis

BACKGROUND

Tracheostomy is an operative intervention for patients who require ventilator assistance while in the intensive care unit (ICU). This study aimed to compare efficacy and safety between early tracheostomy (ET) and late tracheostomy (LT) in stroke patients.

METHODS

Embase, PubMed, and the Cochrane Library were searched for available studies. Stroke-related patients were categorized into ET and LT groups using seven days as the cutoff timepoint. The primary efficacy outcome was mortality; secondary efficacy outcomes were modified Rankin Scores (mRS) obtained at follow up, as well as durations of hospital stay, ICU stay, and ventilator use. Safety outcomes were total complication and ventilator associated pneumonia (VAP) incidence.

RESULTS

Nine studies with 3,789 patients were included in the current analysis. No statistical difference in mortality was observed. ET was associated with shorter hospital stay (MD -5.72, 95% CI -9.76 to -1.67), shorter ICU stay (MD -4.77, 95% CI -6.82 to -2.72), and shorter ventilator duration (MD -4.65, 95% CI -8.39 to -0.90); however, no statistically significant difference was found in follow-up mRS scores. Examination of safety measures found the ET group exhibited a lower rate of VAP compared with LT (OR 0.80, 95 % CI 0.68 to 0.93), while no statistical difference was found in total complications.

CONCLUSION

Our meta-analysis concluded that ET was associated with shorter hospital stay, less time on a ventilator, and lower incidence of VAP. Future studies are warranted to investigate the functional outcomes and the occurrence of complications of ET in stroke patients.

[Pediatric tracheotomy: clinical analysis of 95 cases with different etiology]

Objective:To disscuss the changes in indications, surgical opportunity and post-operative management of pediatric tracheotomy. Methods:Retrospective cohort study of pediatric patients undergoing tracheostomy between January 2016 and December 2020 at Children's Hospital of Fudan University. Ninety-five patients were divided into four groups according to their primary indication. Group A: neuromuscular disease（n=36, 37.9%）, Group B: congenital abnormality（n=30, 31.6%）, Group C: accidental injury（n=15, 15.8%）, Group D: tumor（n=14, 14.7%）. Results:By the comparison between four groups, children in group A had higher incidence of Severe pneumonia（47.2%）, higher usage of mechanical ventilation（97.2%）, longer hospitalization days（=84.9 days） and higher rate of Ventilator dependence（66.7%）; children in group B had higher rate of emergency surgery（4.2%）, lower age（median age 2 months） and lower usage of mechanical ventilation（30.0%）; Mortality of the children in group D was the highest（42.9%）. In the recent five years, we saw a increasing tendency in the proportion of group A（28.6%, 35.0%, 38.5%, 44.4%, 43.5%）, and a decreasing tendency of group B（57.1%, 30.0%, 38.5%, 33.3%, 21.7%）. On discharge, 50.5% of children（48 of 95）spontaneously breathe with the tracheos tomy in situ, 29.5% of children（28 of 95）had ventilator-dependence, tracheostomy decannulation was successful in 6.3% of children （6 of 95） and all-cause mortality was 13.7% （13 of 95）. Conclusion:Most paediatric tracheotomies were performed due to chronic underlying diseases. Pediatric tracheostomy should be considered as a long-term intervention in many children. Earlier tracheotomy can shorten the duration of post-tracheotomy mechanical ventilation in several conditions.

The pattern of hospital-community-home (HCH) nursing in tracheostomy patients with severe traumatic brain injury: Is it feasible?

BACKGROUND

Tracheostomy is very common in patients with severe traumatic brain injury (TBI), long-term nursing care are needed for those patients. We aimed to evaluate the effects of hospital-community-home (HCH) nursing in those patients.

METHODS

This study was a before-after study design. Patients were divided into control groups (traditional nursing care) and HCH group(HCH nursing care). Tracheostomy patients with severe TBI needing long-term care were included. All patients underwent a two-month long follow-up. Glasgow coma score (GCS), Karnofsky, Self-Anxiety Scale (SAS) from caregiver and Barthel assessment at the discharge and two months after discharge were evaluated. The tracheostomy-related complications were recorded and compared.

RESULTS

A total of 60 patients were included. There were no significant differences between the two groups in the GCS, Karnofsky, SAS from caregiver and Barthel index at discharge((all P > .05); the GCS, Karnofsky and Barthel index were all significantly increased after two-month follow-up for the two groups (all P < .05), and the GCS, Karnofsky and Barthel index at two-month follow-up in HCH group were significantly higher than that of the control group(all P < .05), but the SAS from caregiver at two-month follow-up in HCH group was significantly less than that of the control group(P = .009). The incidence of block of artificial tracheal cannula and readmission in HCH group were significant less than that of control group (all P < .05).

CONCLUSION

HCH nursing care is feasible in tracheostomy patients with severe TBI, future studies are needed to further evaluate the role of HCH nursing care.

Risk factors and pathogenic microorganism characteristics for pneumonia in convalescent patients with stroke: A retrospective study of 380 patients from a rehabilitation hospital

BACKGROUND

Pneumonia is a major complication leading to death after stroke. The risk factors of pneumonia in convalescent patients who have experienced stroke remain poorly defined.

METHODS

To identify the risk factors of pneumonia, we applied logistic regression as a statistical method using SPSS23.0 statistical software, based on a sample of 380 patients. And statistical description method was used to analyze pathogens' characteristics and drug resistance.

RESULTS

Ultimately, the obtained logistic model has statistical significance (χ2(13) = 91.560, P <0.0005). The sensitivity of the model is 41.7%, the specificity is 97.6%, the positive predictive value is 76.9%, and the negative predictive value is 89.8%. The Barthel index (BI) (OR=1.97, 95% CI: 1.01-3.87), basic lung diseases (OR=4.24, 95% CI: 1.02-17.61), trachea ventilation (OR=6.56, 95% CI: 1.18-36.34), feeding tube (OR=6.06, 95% CI: 2.59-14.18), and hypoproteinemia (OR=3.97, 95% CI: 1.56-10.10) were statistically significant (P<0.05). Among patients who have pneumonia, the proportion of gram-positive bacteria, gram-negative bacteria and fungal infection is 10.00%, 54.29%, 5.71% respectively. The study most frequently isolated Pseudomonas aeruginosa (18.57%), followed by Acinetobacter baumannii (10.00%,) and Klebsiella pneumoniae (10.00%). The drug resistance rate of Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae to different antibiotics ranged from 0.00-37.77%, 0.00-85.71% and 0.00-57.14%, respectively.

CONCLUSIONS

The lower BI scores, basic lung diseases, trachea ventilation, tube feeding, and hypoproteinemia are independent risk factors of pneumonia among convalescent patients with stroke. The main pathogens that caused pneumonia were gram-negative bacteria, and such organisms have different degrees of resistance to drugs.