Risk Factors for Tracheostomy Infection in Ventilator-dependent Patients
摘要
Tracheostomy is a common procedure in mechanically ventilated patients. The incidence of tracheostomy stoma infection (TSI) varies among different institutes. The aim of this study was to investigate whether patients' characteristics, peri-operative data and tracheostomy cuff deflation were associated with TSI. Patients receiving tracheostomy operation in respiratory intensive care unit of our institution from April 2005 to May 2006 were studied retrospectively. Some of them received tracheostomy cuff deflation after operation. Patients' characteristics, peri-operative conditions and tracheostomy cuff deflation were reviewed from their medical records. TSI was defined as erythematous change, swelling around wound, purulent discharge from wound and discharge culture with bacterial growth. The difference among those factors in TSI and non-TSI patients and those with and without tracheosotmy cuff deflation was examined. Eighty-six patients who received tracheostomy were included. TSI occurred in 12 patients (13%). Leukocytosis before tracheostomy was associated with TSI (15993±1730 vs 11134±415 cells/μl, P=0.004). Persistent or increased pulmonary infiltrates were more common in TSI than in non-TSI patients (91.7% vs 64.9% P=0.094). The rates of TSI were similar between patients with and without tracheostomy cuff deflation (5/43 vs 7/43, P=0.378) but mortality rate was higher in patients without tracheosotmy cuff deflation (23.3% vs 7%, P=0.034). None of mortality cases died of tracheostomy. Surgeons should be aware of the possibility of TSI if the patient has leukocytosis and residual pulmonary infiltrates were found on CXRs before operation. In this study, tracheostomy cuff deflation did not reduce TSI. The casual relationship between tracheosotmy cuff deflation and mortality needs further study.