From one patient (patient 8), lower airway secretions were not taken before the tracheotomy; otherwise data collection was complete. This patient did not develop a lower airway infection preoperatively. Taking this into account, the statistical analysis was based on 21 patients, in the transtracheally intubated group, while data were complete for all 22 patients in the tracheotomy period. A total of 336 oropharyngeal swabs (130 pretracheotomy and 206 posttracheotomy) were obtained, while 232 lower airway samples (83 pretracheotomy and 149 posttracheotomy) were received from the study patients.
During transtracheal ventilation, 15 of 21 patients (71%) were colonized in the lower airways compared to 20 of 21 (95%), posttracheotomy. This difference was statistically significant (p=0.03). significant health problem
The type of ventilation (oropharyngeal or tracheotomy) did not cause any significant change in lower airways infections (8 vs 6; p=0.8), the number of infection episodes (8 vs 9; p<0.8), or the type of bacterium. There was a significant difference on comparing the proportions of infected vs colonized patients (8/15 vs 6/21; p=0.013). There were 8 intubated children and 6 children with tracheotomies who had a total of 17 lower airway infections, 5 episodes of tracheobronchitis, and 12 episodes of pneumonia. Pretracheotomy, the lower airway infection was clinically manifest at a median of 11 days (range, 8 to 25 days; 95% Cl, 8 to 25), while posttracheotomy, the lower airways infection occurred at a median of 22 days (range, 1 to 62 days; 95% Cl, 1 to 62) (p=0.25). The same four potential pathogens, including H influenzae, S aureus, Acin-etobacter baumannii, and Pseudomonas aeruginosa, caused infections during both study periods.
The 22 study patients were receiving a total of 435 days of transtracheal ventilation, while they received ventilation via a tracheostomy for a total of 829 days (Table 1). There was a nonsignificant but appreciable difference in numbers of infection episodes per 1,000 ventilation days: 18 vs 10 (p<0.06) pretracheotomy vs posttracheotomy, with an overall of 13 infections per 1,000 ventilation days (17/435 + 829).
Tags: children, colonization, infection, pathogenesis, tracheotomy, transtracheal intubation