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Impact of Tracheotomy on Colonization and Infection of Lower Airways in Children Requiring Long-term Ventilation: Conclusion

Our observational cohort study demonstrated that the placement of tracheotomy did achieve its clinical goal, ie, although practically all children with tracheotomies were colonized, they suffered significantly fewer infections (one of four patients). Some physicians may argue that this infection rate of 27% does not justify preventative interventions. Although the main problem was of primary endogenous origin, the exogenous pathway was found to be substantial. The 35% exogenous colonization and infection episodes may be traditionally interpreted as a huge crossinfection problem due to bad nursing practices. However, two observations were highlighted by this study that are in line with previous work in this particular patient population. First, despite high standards of hygiene, maintaining sterility of the lower airways in patients with tracheotomies seems impossible. Second, systemic antibiotics fail to sterilize the lower ainvays in these patients, once they are colonized or infected. However, we believe that the persistent colonization state of the lower airways is not normal or physiologic and that attempts should be undertaken to keep lower airways free of potential pathogens. Lepper et al reported that in poliomyelitis patients with tracheotomies aerosolized polymyxin prevented P aeruginosa colonization and infection of the lower airways. The traditional attempts by Lowbury et al to control infection by blocking some of the sources of P aeruginosa were unsuccessful. Klastersky et al have demonstrated the apparent benefit of prophylactic endotracheal gentamicin in the prevention of Gram-negative bacterial lower ainvays infections in patients with tracheotomies. However, endobronchial administration of these agents has not been widely accepted, in part because of concerns regarding adverse reactions and colonization with resistant strains. In addition to the oral and gut SDD, Luiten et al applied a 2% polymyxin, tobramycin, and amphotericin B paste onto the tracheotomy site to prevent direct acquisition of PPMs and subsequent exogenous colonization and infection of the lower airways. More studies are required to evaluate whether this combined procedure effectively controls colonization and infection of both endogenous and exogenous origin in patients requiring tracheotomy. Frontometaphyseal Dysplasia

Category: Tracheotomy

Tags: children, colonization, infection, pathogenesis, tracheotomy, transtracheal intubation