Frequency of Ventilator-Associated Pneumonia among ICU Admitted Patients with Early Versus Delayed Tracheostomy

Objective:  Patients on mechanical ventilation in the intensive care unit (ICU) frequently develop ventilator-associated pneumonia (VAP), an acquired lung infection. The incidence of VAP varies highly in different setups. This study aimed to determine the incidence of VAP in the surgical ICU and the associated costs. Materials & Methods:  An observational cross-sectional study was conducted and included 116 patients who had a tracheostomy in the surgical ICU of Lahore General Hospital. They were observed for the occurrence of VAP, mortality, ICU stay in days, and cost of the ICU stay. Tracheostomies done before 7 days from mechanical ventilation with the expectation of needing extended ventilatory support were classified as early tracheostomies (Group E), whereas those performed after 7 days owing to failure to wean were classified as late tracheostomies (Group L). Results:  Patients in the early tracheostomy group had a mean age of 45.16 years, while those in the late tracheostomy group had a mean age of 50.00 years. Compared to the early tracheostomy group, the late tracheostomy group had a greater incidence of VAP, 8(25.8%) and 24(53.33%), and mortality, 8(25.8%) and 22(48.88%), respectively. Mean values like pre-tracheostomy ventilation were 4.70 & 12.17 days, ICU stay was 9.54 & 16.64 days and total cost in PKR was 796774.19 & 1438888, respectively among early tracheostomy & late tracheostomy groups.  Conclusion:  The occurrence of VAP and mortality is significantly lower in patients who have undergone early tracheostomy.