Comparison between Tracheostomy and No Tracheostomy on the Incidence of Ventilator-associated Pneumonia (VAP) Using the Modified Clinical Pulmonary Infection Score (MCPIS) in Patients in the Intensive Care Unit (ICU) at Wahidin Sudirohusodo Hospital, Makassar

Background and aim The aspiration of pathogens from colonized oropharyngeal secretions across the Endotracheal Tube (ETT), which then grow on the ETT surface, is the primary pathogenic mechanism for the development of VAP. One of the scoring systems for the diagnosis and evaluation of pneumonia is the modified clinical pulmonary infection score (MCPIS). This score assesses body temperature, leukocyte count, volume and characteristics of tracheal secretions, oxygenation, and chest radiography. ETT intubation or tracheostomy is essential for maintaining airway patency, reducing dead space, facilitating suctioning, and improving oxygenation. This study aimed to determine the comparison between tracheostomy and non-tracheostomy on the incidence of VAP in the ICU of Wahidin Sudirohusodo Hospital, Makassar. Methods Using a prospective cohort study on non-traumatic brain injury patients who require long-term airway patency support. This research was conducted by assessing the MCPIS before and after the tracheostomy procedure and in the non-tracheostomy group in the ICU of Wahidin Sudirohusodo Hospital, Makassar. Results There were 25 patients with tracheostomy and 25 patients without tracheostomy, the majority being male (66%) with a mean age of 42.7 years. When the total MCPIS scores were compared after the procedure, there was a significant difference, where the mean total score for the tracheostomy group was significantly lower than the non-tracheostomy group, at 3.20 compared to 5.60 (p < 0.05). In the tracheostomy group, there was a significant decrease in the mean scores for temperature, tracheal secretions, and oxygenation after the procedure compared to before the procedure (all with p < 0.05). In contrast, the leukocyte and chest X-ray scores showed no significant difference (all with p > 0.05). In the non-tracheostomy group, there was a significant increase in the mean temperature score at the day-nine evaluation compared to the second day of treatment (p < 0.05). Meanwhile, the scores for leukocyte count, tracheal secretions, oxygenation, and chest X-ray showed no significant difference (all with p > 0.05). Conclusions There is a significant relationship between performing a tracheostomy and not performing a tracheostomy on the incidence of VAP.