Early Tracheostomy in Prolonged Mechanical Ventilation Due to Severe Head Injury to Prevent Ventilator-Associated Pneumonia (VAP)

Abstract

Introduction: Early tracheostomy needs to be considered if the use of a ventilator is expected to be used for a long time. Early Tracheostomy is recommended because it can improve respiratory function, reduce the risk of Ventilator-Associated Pneumonia, improve patient comfort, cleanse secretions in the throat, reduce laryngeal ulceration, improve mobilization, and speech efforts, and allow treatment outside the Intensive Care Unit (ICU). Case Report: We report four cases of severe head injury with early tracheostomy which illustrates prevent of VAP. In these four cases, early tracheostomy was performed (£ 4 days) with consideration of the initial critical GCS, the location of the lesion, and mechanical ventilation is expected to be used for a long period time. During treatment, there is no VAP which is evidenced by a sputum culture examination. Based on a meta-analysis study early tracheostomy can reduce mortality due to VAP by up to 50% and reduce the length of stay in ICU compared to delayed/late tracheostomy (> 10 days) or prolonged intubation (> 14 days). Conclusion: VAP prevention efforts are carried out by applying VAP Bundle. An early tracheostomy provides more benefits than prolonged intubation or delayed/late tracheostomy. VAP Bundle is performed on every patient who uses a ventilator, and it can be proven scientifically that the application of VAP Bundle can reduce the incidence of VAP by up to 25%.