Role of early tracheostomy for preventing ventilator associated pneumonia in intensive care unit: a review


  • Santosh Kumar Swain Department of Otorhinolaryngology and Head-Neck Surgery, IMS and SUM hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
  • Pragnya Paramita Jena Department of Microbiology, IMS and SUM hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India



Ventilator associated pneumonia, Tracheostomy, Mechanical ventilation, Intensive critical care unit


Tracheostomy often plays a crucial role in airway management of the patients in intensive critical unit (ICU). Tracheostomy is often helpful for improvement of the respiratory mechanics and the patient comfort. There are several advantages of the trachesotomy over the endotracheal tube intubation such as avoidance of the injury of the larynx, provide a stable airway, facilitates pulmonary toilet and facilitates ventilation. It has been suggested that tracheostomy also helpful to reduce the risk of ventilator associated pneumonia (VAP) in comparison to the trans-laryngeal intubation. VAP is a type of nosocomial infection which has been associated with presence of mechanical ventilation. Despite significant improvement in managing the intubated patients, VAP remains a common and sometimes fatal complication in the ICU. Clinician’s attitude towards trachesotomy may be still heterogeneous in ICU and the decision for performing tracheostomy is still challenging. However, early tracheostomy is associated with less VAP, less ICU stay, avoid higher number of intubation in early group of tracheostomy and higher patient comfort. The purpose of this review article was to discuss the etiopathology of VAP, epidemiology, role of early tracheostomy in VAP and prevention of the VAP in patients with mechanical ventilation in ICU.


Freeman BD, Morris PE. Tracheostomy practice in adults with acute respiratory failure. Crit Care Med. 2012;40(10):2890-6.

Fernandez JF, Levine SM, Restrepo MI. Technologic advances in endotracheal tubes for prevention of ventilator-associated pneumonia. Chest. 2012;142(1):231-8.

Lorente L, Lecuona M, Jimenez A, Mora ML, Sierra A. Influence of an endotracheal tube with polyurethane cuff and subglottic secretion drainage on pneumonia. Am J Respir Crit Care Med. 2007;176(11):1079-83.

Veenith T, Ganeshamoorthy S, Standley T, Carter J, Young P. Intensive care unit tracheostomy: a snapshot of UK practice.Int Arch Med. 2008;1(1):21.

Swain SK, Behera IC, Sahu MC. Bedside open tracheostomy at intensive care unit-Our experiences of 1000 cases at a tertiary care teaching hospital of eastern India. Egyptian Journal of Ear, Nose, Throat and Allied Sciences. 2017;18(1):49-53.

Martin SJ, Yost RJ. Infectious diseases in the critically illpatients. J Pharm Pract. 2011;24(1):35-43.

Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, MartinCD, et al. International study of the prevalence outcomes ofinfection in intensive care units. JAMA. 2009;302(21):2323-9.

Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care. 2002;165(7):867-903.

American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care. 2005;171(4):388-416.

Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med. 2005;33(10):2184-93.

Muscedere JG, Martin CM, Heyland DK. The impact of ventilator-associated pneumonia on the Canadian health care system. J Crit Care. 2008;23(1):5-10.

Warren DK, Shukla SJ, Olsen MA, Kollef MH, Hollenbeak CS, Cox MJ, et al. Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Crit Care Med. 2003;31(5):1312-17.

Swain SK, Shajahan N. Managing the airway of acid burn contracture of the neck in a 12-year-old girl. J Sci Soc. 2020;47:122-5.

Niederman MS. The clinical diagnosis of ventilator-associated pneumonia. Respir Care. 2005;50(6):788-96.

Torres A, Ewig S, Lode H, Carlet J. Defining, treating and preventing hospital acquired pneumonia: European perspective. Intens Care Med. 2009;35(1):9-29.

Terragni PP, Antonelli M, Fumagalli R, Faggiano C, Berardino M, Pallavicini FB, et al. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA. 2010;303(15):1483-89.

Robriquet L, Fourrier F. Oral hygiene and ventilator-associated pneumonia. Curr Respir Med Rev. 2010;6(1):65-71.

Olson ME, Harmon BG, Kollef MH. Silver-coated endotracheal tubes associated with reduced bacterial burden in the lungs of mechanically ventilated dogs. Chest. 2002;121(3):863-70.

Soares RB, Costa DH, Miyakawa W, Delgado MG, Garcez AS, Yoshimura TM, et al. Photodynamic activity on biofilm in endotracheal tubes of patients admitted to an intensive care unit. Photochem Photobiol. 2020;96(3):618-24.

Fernandez NB, Caceres DH, Beer KD, Irrazabal C, Delgado G, Farias L, et al. Ventilator-associated pneumonia involving Aspergillus flavus in a patient with coronavirus disease 2019 (COVID-19) from Argentina. Medical mycology case reports. 2021;31:19-23.

Swain SK, Das S, Padhy RN. Performing tracheostomy in intensive care unit-A challenge during COVID-19 pandemic. Siriraj Med J. 2020;72(5):436-42.

Melsen WG, Rovers MM, Koeman M, Bonten MJ. Estimation of the attributable mortality of ventilator associated pneumonia from randomized prevention studies. Critical Care Med. 2011;39(12):2736-42.

Swain SK, Acharya S, Das S. Social impact of tracheostomy: our experiences at a tertiary care teaching hospital of eastern India. J Scient Soc. 2020;47(3):148.

Swain SK, Das A, Behera IC, Bhattacharyya B. Tracheostomy among pediatric patients: a review. Ind J Child Heal. 2018;5(9):557-61.

Hunter JD. Effects of anaesthesia on the human immune system. Hosp Med. 1999;60(9):658-63.

Choudhuri AH, Chakravarty M, Uppal R. Influence of admission source on the outcome of patients in an intensive care unit. Indian J Critical Care Soc. 2017;21(4):213.

Young D, Harrison DA, Cuthbertson BH, Rowan K, TracMan Collaborators. Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial. JAMA. 2013;309(20):2121-9.

Swain SK, Sahu A. Performing tracheostomy on COVID-19 pediatric patients at intensive care unit: our experiences. Ind J Heal Sci Biomed Res. 2021;14(1):131.

Ewig S, Torres A, El-Ebiary M, Fabregas N, Hernandez C, Gonzalez J, et al. Bacterial colonization patterns in mechanically ventilated patients with traumatic and medical head injury: incidence, risk factors, and association with ventilator-associated pneumonia. Am J Respir Crit Care Med. 1999;159(1)):188-98.

Giacobbe DR, Battaglini D, Enrile EM, Dentone C, Vena A, Robba C,et al. Incidence and prognosis of ventilator-associated pneumonia in critically ill patients with COVID-19: a multicenter study. Journal of clinical medicine. 2021;10(4):555-68.

Cook DJ, Walter SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med. 1998;129(6):433-40.

Kollef MH. Ventilator-associated pneumonia: a multivariate analysis. JAMA. 1993;270(16):1965-70.

Torres A, Gatell JM, Aznar E. Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. Am J Respir Crit Care Med. 1995;152(1):137-41.

Swain SK, Sahu MC, Choudhury J, Bhattacharyya B. Tracacheostomy among pediatric patients: our experiences at a tertiary care teaching hospital in eastern India. Pediatria Pol. 2018;93(3):312-17.

Swain SK, Acharya S. Bedside tracheostomy on COVID-19 patients in the intensive care unit: A retrospective study. Airway. 2021;4(1):28-34.

Nieszkowska A, Combes A, Luyt CE, Ksibi H, Trouillet JL, Gibert C, et al. Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients. Critical Care Med. 2005;33(11):2527-33.

Torres A, Aznar KMGE, M el-Ebiary, Bellacasa JPDL, González J, Ferrer M, Rodriguez-Roisin R. Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. Am J Respir Crit Care Med. 1995;152(1):137-41.

Freeman BD, Borecki IB, Coopersmith CM, Buchman TG. Relationship between tracheostomy timing and duration of mechanical ventilation in critically ill patients. Critical Care Med. 2005;33(11):2513-20.

Frutos-Vivar F, Esteban A, Apezteguía C, Anzueto A, Nightingale P, González M, et al. Outcome of mechanically ventilated patients who require a tracheostomy. Critical Care Medi Soc. 2005;33(2):290-8.

Swain SK, Behera IC, Ananda N. Pediatric tracheostomy in COVID-19 pandemic: a review. International Journal of Contemporary Pediatrics. 2021;8(3):602-8.

Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Critical Care Med. 2004;32(8):1689-94.

Griffiths J, Barber VS, Morgan L, Young JD. Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ. 2005;330(7502):1243.

Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive care medicine. 2020;46(5):888-906.

Terragni PP, Antonelli M, Fumagalli R, Faggiano C, Berardino M, Pallavicini FB, et al. Early versus late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA. 2010;303(15):1483-89.

Schneider GT, Christensen N, Doerr TD. Early tracheotomy in elderly patients results in less ventilator-associated pneumonia. Head Neck Surgery. 2009;140(2):250-5.

Dezfulian C, Shojania K, Collard HR, Kim HM, Matthay MA, Saint S. Subglottic secretion drainage for preventing ventilator-associated pneumonia: a meta-analysis. Am J Med. 2005;118:11-8.






Review Articles