{"paper_id":"2d2e9d2e-2729-48d3-8b02-db61b346ac75","body_text":"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 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article 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 Ilham Murtala, Sutji Pratiwi Rahardjo, Khaeruddin HA, Muh. Fadjar Perkasa, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7349120/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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. Tracheostomy modified clinical pulmonary infection score (MCPIS) Ventilator Associated Pneumonia (VAP) Introduction In healthy patients, the colonization of bacteria that gain access to the respiratory tract can be prevented by the body's defenses, such as coughing, mucociliary clearance, epithelial lining fluid and surfactant components, and cellular and humoral immune responses. If these defenses are compromised, pneumonia can easily occur.( 1 , 2 ) Pulmonary aspiration of colonized oropharyngeal secretions that bypass the endotracheal tube (ETT) is the main pathogenic mechanism for the development of VAP. Pathogens can also grow on the inner surface of the ETT and eventually migrate to the lungs. ( 2 , 3 ) VAP has been associated with more deaths than infections in other parts of the body, making it the second most common nosocomial infection and the leading cause of death from nosocomial infections among critically ill patients.4 Several scoring systems have been developed to diagnose, evaluate therapy, and determine the severity of pneumonia in patients. One of the parameters for a clinical pulmonary infection score is the Clinical Pulmonary Infection Score (CPIS).( 5 , 6 ) The CPIS is easy to calculate, but it requires microbiological data that is not immediately available. Therefore, the Modified CPIS (MCPIS) was developed to assess signs and symptoms in patients.( 5 , 7 ) A tracheostomy is a procedure that can reduce airway obstruction or protect the airway by creating a direct opening into the trachea through the skin of the neck. It can assist in the recovery of patients requiring long-term ventilation, reduce the duration of mechanical ventilation and the length of stay in the ICU, and decrease complications from prolonged tracheal intubation.( 8 , 9 ) Based on the description above, the researchers are interested in conducting a study to determine the comparison between tracheostomy and non-tracheostomy on the incidence of VAP in the ICU of Wahidin Sudirohusodo Hospital, Makassar. Patients and Methods This study uses a prospective cohort design on non-traumatic brain injury patients who require long-term airway patency support. The study was conducted by assessing the MCPIS before and after a tracheostomy and without a tracheostomy in the ICU of Wahidin Sudirohusodo Hospital, Makassar, from March 2024 to April 2025. Research Sample Samples were chosen using a consecutive sampling technique according to the inclusion and exclusion criteria. The inclusion criteria for this study were ICU patients on mechanical ventilation with an indication for a tracheostomy. The exclusion criteria for the tracheostomy sample were coagulation dysfunction, neck trauma, infection at the insertion site, thoracic trauma with respiratory distress, a history of lung disease before intubation, or death or forced discharge within 5 days after the tracheostomy. Meanwhile, the exclusion criteria for the non-tracheostomy sample were patients with thoracic trauma and respiratory distress, a history of lung disease before intubation, or death or forced discharge within 9 days of ICU care. The independent variables in this study were tracheostomy and non-tracheostomy. The confounding variables were age, comorbidities, and GCS. The dependent variable was the MCPIS, where an MCPIS ≤6 indicated the patient experienced VAP and an MCPIS >6 indicated the patient did not experience VAP. The patients were assessed using the MCPIS criteria listed in Table 1. Table 1. MCPIS components Components Point Temperature 0 C ≥ 36,5 and ≤ 38,4 ≥ 38,5 and ≤ 38,9 or ≥36,1 and ≤36,4 ≥ 39,0 and ≤ 36,0 0 1 2 Blood Leukocytes (mm 3 ) ≥ 4.000 and ≤11.000 <4.000 or >11.000 + band forms ≥50% 0 1 Tracheal Secretion None There is non-purulent tracheal discharge There is purulent tracheal discharge 0 1 2 Oxygenation (PaO 2 /FiO 2 , mmHg) >240 or ARDS <240 and no ARDS 0 2 Chest X-ray Partial or diffuse infiltrate Local infiltrate 1 2 In tracheostomy patients, the MCPIS score will be assessed before the procedure and on the seventh day after the procedure. In patients without a tracheostomy, the MCPIS score will be assessed on the second and ninth days of treatment. Based on these results, the relationship between tracheostomy and non-tracheostomy with the incidence of VAP will be analyzed using the X-test 2 . Results During the period from March 2024 to April 2025, 25 patients with tracheostomies and 25 patients without tracheostomies were enrolled. These patients consisted of 33 males (66%) and 17 females (34%), with an average age of 42.7 years. In Table 2 , the tracheostomy group found that there was a significant decrease in the mean score of temperature, tracheal secretion and oxygenation after the procedure compared to before the procedure (all with p < 0.05) while there was no significant difference in leukocytes and chest radiographs (all with p > 0.05). In the group without tracheostomy there was a significant increase in the mean score of temperature after the procedure compared to before the procedure (p < 0.05) while there was no significant difference in leukocytes, tracheal secretion, oxygenation and chest radiographs (all with p > 0.05). Table 2 Comparison of MCPIS Component Scores between Before and After Action Group Components n Mean SD p Tracheostomy Pre-Temperature 25 0,68 0,90 0,009 Post-Temperature 25 0,16 0,47 Pre-Leukocytes 25 0,64 0,49 0,564 Post-Leukocytes 25 0,56 0,51 Pre-Tracheal Secretions 25 1,92 0,28 0,003 Post-Tracheal Secretions 25 1,36 0,70 Pre-Oxygenation 25 0,32 0,75 0,046 Post-Oxygenation 25 0,00 0,00 Pre-Thorax X-Ray 25 1,36 0,81 0,222 Post-Thorax X-Ray 25 1,12 0,88 Without Tracheostomy Pre-Temperature 25 0,68 0,80 0,022 Post-Temperature 25 1,36 0,81 Pre-Leukocytes 25 0,88 0,33 0,058 Post-Leukocytes 25 0,64 0,49 Pre-Tracheal Secretions 25 1,92 0,28 0,564 Post-Tracheal Secretions 25 1,88 0,33 Pre-Oxygenation 25 0,48 0,87 1,000 Post-Oxygenation 25 0,48 0,87 Pre-Thorax X-Ray 25 1,08 0,86 0,396 Post-Thorax X-Ray 25 1,24 0,78 Table 3 , comparing the Total MCPIS Score by group, showed a significant decrease in the mean total MCPIS score after the procedure in the tracheostomy group (p < 0.05). Meanwhile, in the non-tracheostomy group, there was an increase in the mean total MCPIS score after the procedure, but this was not statistically significant (p > 0.05). The results of the total MCPIS scores compared to the post-procedure group showed a significant difference, with the mean total score in the tracheostomy group being significantly lower than in the non-tracheostomy group (p < 0.05). Table 3 Comparison of Total MCPIS Scores by Group Dependent variables Group n Mean SD p MCPIS Pre Score Tracheostomy 25 4,92 1,93 0,875 Without Tracheostomy 25 5,04 1,57 MCPIS Post Score Tracheostomy 25 3,20 1,58 0,001 Without Tracheostomy 25 5,60 1,87 Discussion In this study, the sample was predominantly male (66%), with an average age of 42.7 years. This is consistent with research conducted by Indriasari et al. (2024), which found a male proportion (63.3%) of patients diagnosed with VAP. A previous study by El-Anwar et al. (2017) also found that 91.7% of tracheostomy patients in the ICU were male. Research by Anindito et al. (2023) also found that the distribution of tracheostomy patients was higher in males.( 10 – 12 ) These results were in contrasts with the study by Nency C. et al. (2015), which found that 57.2% of patients with VAP were female. Similarly, a study by Muhibbut Thibri et al. (2024) found that 54% of critically ill patients in the ICU with tracheostomies were female (54%).( 13 , 14 ) In this study, age was not a risk factor for VAP, although several studies, such as that by Sutoyo et al. (2025), found that age was a significant contributing factor to the incidence of VAP. These differences in results may be due to variations in the population, research methods, or other factors. In the temperature component, there was a significant decrease in the mean score in the tracheostomy sample and a significant increase in the mean score in the non-tracheostomy sample. As reported by Sudadi et al. (2023), changes in patient temperature during ventilator treatment were observed, with an increase in temperature that subsequently improved after therapy adjustments and further interventions such as tracheostomy.(15 ) Similarly, a study by Achaiah (2023) reported that most fever episodes in the ICU were caused by infection. One of the most common causes of infection is VAP.( 16 ) The results of the studies mentioned above strongly support that body temperature is an adaptive response to infection, as occurs in VAP patients. In the leukocyte component, the mean scores in both groups showed no significant difference. A study conducted by Bima (2022) reported that the etiology of increased leukocyte counts includes infection, malignancy, severe bleeding, acute hemolysis, intoxication, and other stressful conditions such as severe trauma. A study by Viner (2023) showed that infection was the primary cause in cases with WBC counts in the range of 35–50 × 10⁹ leukocytes/L, while malignancy was more frequently found in patients with WBC counts > 50 × 10⁹ leukocytes/L. One of the most common infectious etiologies is pneumonia. Risk factors or underlying pathogens did not show a correlation with leukocyte counts. ( 17 , 18 ) The results of our study are consistent with previous researchers who explained that leukocyte counts are strongly influenced by various etiologies and therefore cannot be a key point in the MCPIS component. In the tracheal secretion component, there was a significant decrease in the mean score after tracheostomy. Meanwhile, there was no significant difference in the mean score without tracheostomy. Opening the upper airway due to ETT placement reduces the body's ability to filter and warm air. Disruption of the ciliary defense of the airway mucosa due to intubation can provide a place for bacteria to colonize the trachea, which will result in increased secretion production. Stagnant secretions become a medium for bacterial growth. Buston (2020) study reported that the majority of respondents (79.3%) had large amounts of secretions and experienced VAP, and there was a significant association between the amount of tracheal secretions and the incidence of VAP.( 19 ) The significance of these study results aligns with the goals of tracheostomy: reducing bacterial colonization from ETT insertion and facilitating pulmonary toilet, thereby reducing tracheal secretion production. In the oxygenation component, there was a significant decrease in the mean oxygenation score after tracheostomy. Meanwhile, the mean oxygenation score without tracheostomy showed no significant difference. A decrease in the PaO₂/FiO₂ ratio is an indicator of impaired oxygenation in VAP patients. A study published by Mark Le Pape et al. (2022) showed that ARDS patients with VAP experienced a decrease in this ratio. This indicates that VAP impacts oxygenation, but is reversible with appropriate treatment.( 20 ) This contrasts with research by Ferrer et al. (2019) which found that adding a PaO2/FiO2 ratio ≤ 240 to the clinical record did not significantly contribute to establishing a VAP diagnosis. A PaO2/FiO2 ratio > 240 cannot exclude the presence of the infection. The use of this threshold has the potential to cause inaccurate or underestimate VAP incidence calculations.( 21 ) Although there are differences between various studies, the PaO₂/FiO₂ ratio can still be an indicator of impaired oxygenation in VAP patients. In the thorax X-ray component, the mean scores for both the tracheostomy and non-tracheostomy groups showed no significant difference. Radiological assessment via chest X-ray is an important element in the diagnosis and evaluation of patients with VAP. Several studies have demonstrated a strong correlation between radiographic resolution and clinical improvement. Shokouhi et al. (2017) reported that infiltrate resolution on chest X-ray occurred in the majority of patients who successfully emerged from the acute phase of VAP, and that radiographic clearing proceeded more rapidly. These findings also suggest that repeating chest X-rays after clinical improvement provides little additional clinical value, and thus their routine use may warrant reconsideration. Therefore, while chest X-rays are valuable for the early detection of VAP, their benefit in ongoing monitoring should be evaluated in the context of the patient’s overall clinical condition.( 22 ) The results of the total MCPIS score comparison after the intervention revealed a significant difference: the mean total score in the tracheostomy group was significantly lower than in the non-tracheostomy group, at 3.20 versus 5.60 (p < 0.05). These findings demonstrate a significant association between tracheostomy and the incidence of VAP. This is in line with previous research, including Hayoung Seong et al. (2025), who reported that tracheostomy in patients with severe pneumonia requiring prolonged mechanical ventilation significantly reduced 90-day mortality. Moreover, early tracheostomy may offer additional benefits by enhancing the efficiency of health resource utilization. These results highlight the importance of carefully considering the timing of tracheostomy to optimize patient outcomes and healthcare service efficiency.( 23 ) Similarly, the study by Santos Kumar Swain (2021) revealed that early tracheostomy in patients requiring prolonged mechanical ventilation was shown to reduce the incidence of VAP. Compared to late tracheostomy or no tracheostomy, early tracheostomy also improved patient comfort and care efficiency.( 24 ) Tolga Besci et al. (2022), in their study, found a relationship between tracheostomy timing and the incidence of VAP; however, further prospective studies are needed to analyze the causal relationship between ICU morbidity and delayed tracheostomy.( 25 ) Although early tracheostomy is associated with a decreased risk of VAP, the research findings are still inconsistent. A meta-analysis by Moore et al. (2024) found no significant difference in mortality or the incidence of pneumonia between early and late tracheostomy, possibly due to the heterogeneity of the population and the varying definitions of early tracheostomy.( 26 ) A study by Boni A, et al. (2025) conducted a systematic review and meta-analysis of Randomised Clinical Trials (RCTs) to evaluate outcomes between early and late tracheostomy. Despite extensive research, the evidence regarding the benefits of early tracheostomy on the incidence of VAP and mortality remains weak.( 27 ) A study by Hui-Hsuan Lai, et al. (2021) reported that the decision to perform a tracheostomy did not affect the long-term survival or annual medical costs for patients on prolonged mechanical ventilation (PMV). This highlights the importance of individualized treatment planning to reduce mortality and medical expenses.( 28 ) Based on the various research findings above, the majority show that tracheostomy in patients requiring long-term mechanical ventilation is proven to reduce the incidence of VAP, and this result is consistent with our study's findings Declarations Ethic approval : Ethics Commission for Biomedical Research on Humans, Faculty of Medicine, Hasanuddin University, with protocol number 523/UN4.6.4.5.31/PP36/2024. Conflict of Interest: None Authors Contribution: IM (concept, design, literature search, manuscript editing, manuscript review), SPR (concept, literature search, data acquisition, data analysis, manuscript preparation), KHA (literature search, data acquisition, data analysis, manuscript editing), MFP (literature search, data acquisition, manuscript preparation, manuscript editing), AQP (data acquisition, manuscript preparation, manuscript editing) Declaration on the use of AI: None. Consent for publication: None Acknowledgments: None Funding: None References Chastre J, Luyt C-E (2022) Ventilator-Associated Pneumonia. In: Broaddus C, Ernst J, King T, Lazarus S, Sarmiento K, Schnapp L et al (eds) Murray & Nadel’s textbook ofrespiratorymedicine, 7th edn. Elsevier Inc, Philadelphia Vincent J-L, Moore FA, Bellomo R et al (2024) Textbook of Critical Care, 8th edn. Elsevier Inc. All rights reserved Bassi GL, Luque N, Martí JD et al (2015) Endotracheal tubes for critically ill patients: An in vivo analysis of associated tracheal injury, mucociliary clearance, and sealing effi cacy. Chest 147:1327–1335 Loscalzo J, kasper DL, Longo DL et al (2022) Harrison’s Principles of Internal Medicine, 21st edn. McGraw Hill Education, New York NY Madjid AS, Sugiarto A, Putri RP et al (2015) Korelasi Modified Clinical Pulmonary Infection Score dengan Lama Ventilasi Mekanis pada Pasien dengan Pneumonia di UPI RSUPN Cipto Mangunkusumo Kahveci F, Emre G, Berin O, Akalin H et al (2012) Evaluation of a clinical pulmonary infection score in the diagnosis of ventilator-associated pneumonia, Safdar N, O’Horo JC, Mak R et al Agreement between the Clinical Pulmonary Infection Score and NHSN criteria for surveillance of Ventilator Associated Pneumonia. Int J Infect Control; 9. Epub ahead of print 7 February 2013. 10.3396/ijic.v9i1.008.13 Williams NS, O’connell PR, McCaskie AW (2018) 6. Bailey & Love’s Short Practice of Surgery 27th edition, 27th edn. Taylor & Francis Group, LLC Marra A, Vargas M, Buonanno P et al Early vs. Late tracheostomy in patients with traumatic brain injury: Systematic review and meta-analysis. Journal of Clinical Medicine; 10. Epub ahead of print 1 August 2021. 10.3390/jcm10153319 Indriasari AR, Al-Haq MM (2024) Mortality risk factors and the ventilator-associated pneumonia (VAP) in the ICU of a tertiary hospital in Indonesia. Anaesthesia, Pain and Intensive Care. ; 28: 206–213 El-Anwar MW, Nofal AAF, Shawadfy MAE et al (2017) Tracheostomy in the Intensive Care Unit: A University Hospital in a Developing Country Study. Int Arch Otorhinolaryngol 21:33–37 Anindito E, Yusuf M, Ahadiah TH (2023) Correlation between age, the clinical status of patients, operator characteristics, and surgical landmarks with the incidence of tracheotomy complications. Bali Med J 12:954–958 Nency C, Irawan D, Andrini F (2015) Gambaran Kejadian Ventilator-Associated Pneumonia Pada Pasien Yang Dirawat di ICU dan CVCU RSUD Arifin Achmad Periode Januari 2013 S/D Agustus 2014 Thibri M, Muhammad Ihsan LB (2024) Gambaran Komplikasi Percutaneous Dilatational Tracheostomy pada Pasien Kritis di Intensive Care Unit (ICU) RSUP H. Adam Malik Medan. Majalah Anestesia Crit Care 42:227–239 Rahardjo S, Hary Suharso P (2022) Laporan Kasus Weaning Ventilator Pada Pasien Tetraparese Neglecteed Cervical Spondiloptosis Dengan Dislokasi Faset Bilateral Cervical 5–6 Dan Spinal Cord Injury Inkomplet Level Cervical 6 Achaiah NC, Bhutta BS, AK AK (2025) Fever in the Intensive Care Patient Hasjim BJ, Grigorian A, Stopenski S et al (2022) Moderate to severe leukocytosis with vasopressor use is associated with increased mortality in trauma patients. J Intensive Care Soc 23:117–123 Viner E, Berger J, Bengualid V Etiologies of Extreme Leukocytosis. Cureus. Epub ahead of print 24 April 2023. 10.7759/cureus.38062 Buston E, Efrizon H Relationship Of Number Of Secrets With Events Of Vap (Associated Pneumonia Ventilators) In Patients In ICU RSUD. 2020. Epub ahead of print 2020. https://doi.org/10.37676/jnph.v8i2.1176 Le Pape M, Besnard C, Acatrinei C et al Clinical impact of ventilator-associated pneumonia in patients with the acute respiratory distress syndrome: a retrospective cohort study. Ann Intensive Care; 12. Epub ahead of print 1 December 2022. 10.1186/s13613-022-00998-7 Ferrer M, Sequeira T, Cilloniz C et al Ventilator-associated pneumonia and PaO2/FIO2 diagnostic accuracy: Changing the paradigm? J Clin Med; 8. Epub ahead of print 1 August 2019. 10.3390/jcm8081217 Shokouhi S, Niyati R, Darazam IA et al (2017) Resolution of Chest X-Ray Opacities in Patients with Ventilator-associated Pneumonia. Infect Disord Drug Targets 18:23–28 Seong H, Jang H, Yoo W et al (2025) Impact of tracheostomy on clinical outcomes in ventilated patients with severe pneumonia: a propensity-matched cohort study. Korean J Intern Med 40:286–298 Swain SK, Jena PP (2021) Role of early tracheostomy for preventing ventilator associated pneumonia in intensive care unit: a review. Int J Otorhinolaryngol Head Neck Surg 7:1083 Besci T, Ak T, Özdemir G et al (2023) The Effect of Tracheostomy Timing on Clinical Outcomes in Children. J Pediatr Emerg Intensive Care Medicine(Turkey) 10:111–116 Moore AWB, Pitts L, Jasahui MP An updated review in percutaneous tracheostomy. AME Medical Journal; 9. Epub ahead of print 30 December 2024. 10.21037/amj-23-143 Boni A, Tonietto TA, Rihl MF et al Early versus late tracheostomy in critically ill patients: An umbrella review of systematic reviews of randomised clinical trials with meta-analyses and trial sequential analysis. BMJ Open Respir Res; 12. Epub ahead of print 5 April 2025. 10.1136/bmjresp-2024-002434 Lai HH, Tseng PY, Wang CY et al Long-term survival and medical costs of patients with prolonged mechanical ventilation and tracheostomy: A nationwide cohort study. Int J Environ Res Public Health; 18. Epub ahead of print 1 October 2021. 10.3390/ijerph181910272 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-7349120\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":498979086,\"identity\":\"1e1f091d-e486-4788-84ac-620cd8428358\",\"order_by\":0,\"name\":\"Ilham Murtala\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIiWNgGAWjYBAC+XYeOJvxAEMFkGJmbsCrhY0ZpoWNgeEAwxmQFkZStDC2gW0jpIX34KcbDNsSt89vfnDg57zaaP52oJYfFdvwaOFLls5huJ045xibwcHebcdzZxxmbGDsOXMbn8MMwFpmsDEYHODddiy3AaiFmbENrxbj3xAt7B8O/p1zLHc+EVrMoLbwGBzmbajJ3UCMFuscg9vGM9hyCg7LHDuQuxGo5SA+v8i39xjfzqm4LTuD+fjGh29q6nLnnT988MGPCtxaIMAAzjoMJg8QUI8C6khRPApGwSgYBSMEAACILlgThh+yfgAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"Hasanuddin University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Ilham\",\"middleName\":\"\",\"lastName\":\"Murtala\",\"suffix\":\"\"},{\"id\":498979087,\"identity\":\"65cc82be-1c1f-4ff6-b321-a60c4b78f761\",\"order_by\":1,\"name\":\"Sutji Pratiwi Rahardjo\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hasanuddin University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Sutji\",\"middleName\":\"Pratiwi\",\"lastName\":\"Rahardjo\",\"suffix\":\"\"},{\"id\":498979088,\"identity\":\"d800b151-4e31-4aea-bf7e-8fcc7a5770ad\",\"order_by\":2,\"name\":\"Khaeruddin HA\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hasanuddin University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Khaeruddin\",\"middleName\":\"\",\"lastName\":\"HA\",\"suffix\":\"\"},{\"id\":498979089,\"identity\":\"bfcd1722-dea7-4b3c-b17b-626ce378a57d\",\"order_by\":3,\"name\":\"Muh. Fadjar Perkasa\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hasanuddin University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Muh.\",\"middleName\":\"Fadjar\",\"lastName\":\"Perkasa\",\"suffix\":\"\"},{\"id\":498979090,\"identity\":\"26410e4e-be8e-4eaf-a547-e3378736c100\",\"order_by\":4,\"name\":\"Abdul Qadar Punagi\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hasanuddin University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Abdul\",\"middleName\":\"Qadar\",\"lastName\":\"Punagi\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-08-11 18:53:21\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-7349120/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-7349120/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":90179928,\"identity\":\"991c09a5-42c4-4a3e-a3e9-6aee55760831\",\"added_by\":\"auto\",\"created_at\":\"2025-08-29 13:17:09\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":591788,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7349120/v1/55498c5e-5026-45bc-80e9-3b837dffdf01.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"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\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eIn healthy patients, the colonization of bacteria that gain access to the respiratory tract can be prevented by the body's defenses, such as coughing, mucociliary clearance, epithelial lining fluid and surfactant components, and cellular and humoral immune responses. If these defenses are compromised, pneumonia can easily occur.(\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003ePulmonary aspiration of colonized oropharyngeal secretions that bypass the endotracheal tube (ETT) is the main pathogenic mechanism for the development of VAP. Pathogens can also grow on the inner surface of the ETT and eventually migrate to the lungs. (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e) VAP has been associated with more deaths than infections in other parts of the body, making it the second most common nosocomial infection and the leading cause of death from nosocomial infections among critically ill patients.4\\u003c/p\\u003e\\u003cp\\u003eSeveral scoring systems have been developed to diagnose, evaluate therapy, and determine the severity of pneumonia in patients. One of the parameters for a clinical pulmonary infection score is the Clinical Pulmonary Infection Score (CPIS).(\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e) The CPIS is easy to calculate, but it requires microbiological data that is not immediately available. Therefore, the Modified CPIS (MCPIS) was developed to assess signs and symptoms in patients.(\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003eA tracheostomy is a procedure that can reduce airway obstruction or protect the airway by creating a direct opening into the trachea through the skin of the neck. It can assist in the recovery of patients requiring long-term ventilation, reduce the duration of mechanical ventilation and the length of stay in the ICU, and decrease complications from prolonged tracheal intubation.(\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003eBased on the description above, the researchers are interested in conducting a study to determine the comparison between tracheostomy and non-tracheostomy on the incidence of VAP in the ICU of Wahidin Sudirohusodo Hospital, Makassar.\\u003c/p\\u003e\"},{\"header\":\"Patients and Methods\",\"content\":\"\\u003cp\\u003eThis study uses a prospective cohort design on non-traumatic brain injury patients who require long-term airway patency support. The study was conducted by assessing the MCPIS before and after a tracheostomy and without a tracheostomy in the ICU of Wahidin Sudirohusodo Hospital, Makassar, from March 2024 to April 2025.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResearch Sample\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eSamples were chosen using a consecutive sampling technique according to the inclusion and exclusion criteria. The inclusion criteria for this study were ICU patients on mechanical ventilation with an indication for a tracheostomy. The exclusion criteria for the tracheostomy sample were coagulation dysfunction, neck trauma, infection at the insertion site, thoracic trauma with respiratory distress, a history of lung disease before intubation, or death or forced discharge within 5 days after the tracheostomy. Meanwhile, the exclusion criteria for the non-tracheostomy sample were patients with thoracic trauma and respiratory distress, a history of lung disease before intubation, or death or forced discharge within 9 days of ICU care. The independent variables in this study were tracheostomy and non-tracheostomy. The confounding variables were age, comorbidities, and GCS. The dependent variable was the MCPIS, where an MCPIS \\u0026le;6 indicated the patient experienced VAP and an MCPIS \\u0026gt;6 indicated the patient did not experience VAP. The patients were assessed using the MCPIS criteria listed in Table 1.\\u003c/p\\u003e\\n\\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003eTable 1. MCPIS components\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable style=\\\"border-collapse: collapse;border: none;width: 529px;\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 269.45pt;border-right: none;border-bottom: none;border-left: none;border-image: initial;border-top: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;height: 17pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003eComponents\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 127.4pt;border-right: none;border-bottom: none;border-left: none;border-image: initial;border-top: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;height: 17pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003ePoint\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 269.45pt;border: none;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003eTemperature \\u003csup\\u003e0\\u003c/sup\\u003eC\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026ge; 36,5 and \\u0026le; 38,4\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026ge; 38,5 and \\u0026le; 38,9 \\u0026nbsp;or \\u0026nbsp;\\u0026ge;36,1 and \\u0026le;36,4\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026ge; 39,0 and \\u0026le; 36,0\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 127.4pt;border: none;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e0\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e1\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e2\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 269.45pt;border: none;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003eBlood Leukocytes (mm\\u003csup\\u003e3\\u003c/sup\\u003e)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026ge; 4.000 and \\u0026le;11.000\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026lt;4.000 or \\u0026gt;11.000 + band forms \\u0026ge;50%\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 127.4pt;border: none;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e0\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e1\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 269.45pt;border: none;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003eTracheal Secretion\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;None\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;There is non-purulent tracheal discharge\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;There is purulent tracheal discharge\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 127.4pt;border: none;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e0\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e1\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e2\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 269.45pt;border: none;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003eOxygenation (PaO\\u003csub\\u003e2\\u003c/sub\\u003e/FiO\\u003csub\\u003e2\\u003c/sub\\u003e, mmHg)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026gt;240 or ARDS\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026lt;240 and no ARDS\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 127.4pt;border: none;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e0\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e2\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 269.45pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;height: 17pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003eChest X-ray\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Partial or diffuse infiltrate\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Local infiltrate\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 127.4pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;height: 17pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e1\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Times New Roman\\\",serif;'\\u003e2\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eIn tracheostomy patients, the MCPIS score will be assessed before the procedure and on the seventh day after the procedure. In patients without a tracheostomy, the MCPIS score will be assessed on the second and ninth days of treatment. Based on these results, the relationship between tracheostomy and non-tracheostomy with the incidence of VAP will be analyzed using the X-test\\u003csup\\u003e2\\u003c/sup\\u003e.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eDuring the period from March 2024 to April 2025, 25 patients with tracheostomies and 25 patients without tracheostomies were enrolled. These patients consisted of 33 males (66%) and 17 females (34%), with an average age of 42.7 years.\\u003c/p\\u003e\\u003cp\\u003eIn Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e, the tracheostomy group found that there was a significant decrease in the mean score of temperature, tracheal secretion and oxygenation after the procedure compared to before the procedure (all with p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05) while there was no significant difference in leukocytes and chest radiographs (all with p\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). In the group without tracheostomy there was a significant increase in the mean score of temperature after the procedure compared to before the procedure (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05) while there was no significant difference in leukocytes, tracheal secretion, oxygenation and chest radiographs (all with p\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05).\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eComparison of MCPIS Component Scores between Before and After Action\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"9\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eGroup\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e\\u003cp\\u003eComponents\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003en\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003eMean\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c8\\\" namest=\\\"c7\\\"\\u003e\\u003cp\\u003eSD\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003ep\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"9\\\" rowspan=\\\"10\\\"\\u003e\\u003cp\\u003eTracheostomy\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePre-Temperature\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0,68\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e\\u003cp\\u003e0,90\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e\\u003cp\\u003e0,009\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePost-Temperature\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0,16\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e\\u003cp\\u003e0,47\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePre-Leukocytes\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0,64\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e\\u003cp\\u003e0,49\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e\\u003cp\\u003e0,564\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePost-Leukocytes\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0,56\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e\\u003cp\\u003e0,51\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePre-Tracheal Secretions\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1,92\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e\\u003cp\\u003e0,28\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e\\u003cp\\u003e0,003\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePost-Tracheal Secretions\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1,36\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e\\u003cp\\u003e0,70\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePre-Oxygenation\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0,32\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e\\u003cp\\u003e0,75\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e\\u003cp\\u003e0,046\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePost-Oxygenation\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0,00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e\\u003cp\\u003e0,00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePre-Thorax X-Ray\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1,36\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e\\u003cp\\u003e0,81\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e\\u003cp\\u003e0,222\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePost-Thorax X-Ray\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1,12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e\\u003cp\\u003e0,88\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"9\\\" rowspan=\\\"10\\\"\\u003e\\u003cp\\u003eWithout Tracheostomy\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePre-Temperature\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0,68\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e\\u003cp\\u003e0,80\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e\\u003cp\\u003e0,022\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePost-Temperature\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1,36\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e\\u003cp\\u003e0,81\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePre-Leukocytes\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0,88\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e\\u003cp\\u003e0,33\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e\\u003cp\\u003e0,058\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePost-Leukocytes\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0,64\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e\\u003cp\\u003e0,49\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePre-Tracheal Secretions\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1,92\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e\\u003cp\\u003e0,28\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e\\u003cp\\u003e0,564\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePost-Tracheal Secretions\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1,88\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e\\u003cp\\u003e0,33\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePre-Oxygenation\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0,48\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e\\u003cp\\u003e0,87\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e\\u003cp\\u003e1,000\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePost-Oxygenation\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0,48\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e\\u003cp\\u003e0,87\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePre-Thorax X-Ray\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1,08\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e\\u003cp\\u003e0,86\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e\\u003cp\\u003e0,396\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePost-Thorax X-Ray\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1,24\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e\\u003cp\\u003e0,78\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eTable\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e, comparing the Total MCPIS Score by group, showed a significant decrease in the mean total MCPIS score after the procedure in the tracheostomy group (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). Meanwhile, in the non-tracheostomy group, there was an increase in the mean total MCPIS score after the procedure, but this was not statistically significant (p\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). The results of the total MCPIS scores compared to the post-procedure group showed a significant difference, with the mean total score in the tracheostomy group being significantly lower than in the non-tracheostomy group (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05).\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eComparison of Total MCPIS Scores by Group\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"6\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eDependent variables\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eGroup\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003en\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eMean\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eSD\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003ep\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eMCPIS Pre Score\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eTracheostomy\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e4,92\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1,93\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e0,875\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eWithout Tracheostomy\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e5,04\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1,57\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eMCPIS Post Score\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eTracheostomy\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e3,20\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1,58\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e0,001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eWithout Tracheostomy\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e5,60\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1,87\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eIn this study, the sample was predominantly male (66%), with an average age of 42.7 years. This is consistent with research conducted by Indriasari et al. (2024), which found a male proportion (63.3%) of patients diagnosed with VAP. A previous study by El-Anwar et al. (2017) also found that 91.7% of tracheostomy patients in the ICU were male. Research by Anindito et al. (2023) also found that the distribution of tracheostomy patients was higher in males.(\\u003cspan class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e\\u0026ndash;\\u003cspan class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e) These results were in contrasts with the study by Nency C. et al. (2015), which found that 57.2% of patients with VAP were female. Similarly, a study by Muhibbut Thibri et al. (2024) found that 54% of critically ill patients in the ICU with tracheostomies were female (54%).(\\u003cspan class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e) In this study, age was not a risk factor for VAP, although several studies, such as that by Sutoyo et al. (2025), found that age was a significant contributing factor to the incidence of VAP. These differences in results may be due to variations in the population, research methods, or other factors.\\u003c/p\\u003e\\n\\u003cp\\u003eIn the temperature component, there was a significant decrease in the mean score in the tracheostomy sample and a significant increase in the mean score in the non-tracheostomy sample. As reported by Sudadi et al. (2023), changes in patient temperature during ventilator treatment were observed, with an increase in temperature that subsequently improved after therapy adjustments and further interventions such as tracheostomy.(15\\u003csup\\u003e)\\u003c/sup\\u003e Similarly, a study by Achaiah (2023) reported that most fever episodes in the ICU were caused by infection. One of the most common causes of infection is VAP.(\\u003cspan class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e) The results of the studies mentioned above strongly support that body temperature is an adaptive response to infection, as occurs in VAP patients.\\u003c/p\\u003e\\n\\u003cp\\u003eIn the leukocyte component, the mean scores in both groups showed no significant difference. A study conducted by Bima (2022) reported that the etiology of increased leukocyte counts includes infection, malignancy, severe bleeding, acute hemolysis, intoxication, and other stressful conditions such as severe trauma. A study by Viner (2023) showed that infection was the primary cause in cases with WBC counts in the range of 35\\u0026ndash;50 \\u0026times; 10⁹ leukocytes/L, while malignancy was more frequently found in patients with WBC counts\\u0026thinsp;\\u0026gt;\\u0026thinsp;50 \\u0026times; 10⁹ leukocytes/L. One of the most common infectious etiologies is pneumonia. Risk factors or underlying pathogens did not show a correlation with leukocyte counts. (\\u003cspan class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e) The results of our study are consistent with previous researchers who explained that leukocyte counts are strongly influenced by various etiologies and therefore cannot be a key point in the MCPIS component. In the tracheal secretion component, there was a significant decrease in the mean score after tracheostomy. Meanwhile, there was no significant difference in the mean score without tracheostomy. Opening the upper airway due to ETT placement reduces the body\\u0026apos;s ability to filter and warm air. Disruption of the ciliary defense of the airway mucosa due to intubation can provide a place for bacteria to colonize the trachea, which will result in increased secretion production. Stagnant secretions become a medium for bacterial growth. Buston (2020) study reported that the majority of respondents (79.3%) had large amounts of secretions and experienced VAP, and there was a significant association between the amount of tracheal secretions and the incidence of VAP.(\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e) The significance of these study results aligns with the goals of tracheostomy: reducing bacterial colonization from ETT insertion and facilitating pulmonary toilet, thereby reducing tracheal secretion production.\\u003c/p\\u003e\\n\\u003cp\\u003eIn the oxygenation component, there was a significant decrease in the mean oxygenation score after tracheostomy. Meanwhile, the mean oxygenation score without tracheostomy showed no significant difference. A decrease in the PaO₂/FiO₂ ratio is an indicator of impaired oxygenation in VAP patients. A study published by Mark Le Pape et al. (2022) showed that ARDS patients with VAP experienced a decrease in this ratio. This indicates that VAP impacts oxygenation, but is reversible with appropriate treatment.(\\u003cspan class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e) This contrasts with research by Ferrer et al. (2019) which found that adding a PaO2/FiO2 ratio\\u0026thinsp;\\u0026le;\\u0026thinsp;240 to the clinical record did not significantly contribute to establishing a VAP diagnosis. A PaO2/FiO2 ratio\\u0026thinsp;\\u0026gt;\\u0026thinsp;240 cannot exclude the presence of the infection. The use of this threshold has the potential to cause inaccurate or underestimate VAP incidence calculations.(\\u003cspan class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e) Although there are differences between various studies, the PaO₂/FiO₂ ratio can still be an indicator of impaired oxygenation in VAP patients.\\u003c/p\\u003e\\n\\u003cp\\u003eIn the thorax X-ray component, the mean scores for both the tracheostomy and non-tracheostomy groups showed no significant difference. Radiological assessment via chest X-ray is an important element in the diagnosis and evaluation of patients with VAP. Several studies have demonstrated a strong correlation between radiographic resolution and clinical improvement. Shokouhi et al. (2017) reported that infiltrate resolution on chest X-ray occurred in the majority of patients who successfully emerged from the acute phase of VAP, and that radiographic clearing proceeded more rapidly. These findings also suggest that repeating chest X-rays after clinical improvement provides little additional clinical value, and thus their routine use may warrant reconsideration. Therefore, while chest X-rays are valuable for the early detection of VAP, their benefit in ongoing monitoring should be evaluated in the context of the patient\\u0026rsquo;s overall clinical condition.(\\u003cspan class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e)\\u003c/p\\u003e\\n\\u003cp\\u003eThe results of the total MCPIS score comparison after the intervention revealed a significant difference: the mean total score in the tracheostomy group was significantly lower than in the non-tracheostomy group, at 3.20 versus 5.60 (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). These findings demonstrate a significant association between tracheostomy and the incidence of VAP. This is in line with previous research, including Hayoung Seong et al. (2025), who reported that tracheostomy in patients with severe pneumonia requiring prolonged mechanical ventilation significantly reduced 90-day mortality. Moreover, early tracheostomy may offer additional benefits by enhancing the efficiency of health resource utilization. These results highlight the importance of carefully considering the timing of tracheostomy to optimize patient outcomes and healthcare service efficiency.(\\u003cspan class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e) Similarly, the study by Santos Kumar Swain (2021) revealed that early tracheostomy in patients requiring prolonged mechanical ventilation was shown to reduce the incidence of VAP. Compared to late tracheostomy or no tracheostomy, early tracheostomy also improved patient comfort and care efficiency.(\\u003cspan class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e)\\u003c/p\\u003e\\n\\u003cp\\u003eTolga Besci et al. (2022), in their study, found a relationship between tracheostomy timing and the incidence of VAP; however, further prospective studies are needed to analyze the causal relationship between ICU morbidity and delayed tracheostomy.(\\u003cspan class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e)\\u003c/p\\u003e\\n\\u003cp\\u003eAlthough early tracheostomy is associated with a decreased risk of VAP, the research findings are still inconsistent. A meta-analysis by Moore et al. (2024) found no significant difference in mortality or the incidence of pneumonia between early and late tracheostomy, possibly due to the heterogeneity of the population and the varying definitions of early tracheostomy.(\\u003cspan class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e) A study by Boni A, et al. (2025) conducted a systematic review and meta-analysis of Randomised Clinical Trials (RCTs) to evaluate outcomes between early and late tracheostomy. Despite extensive research, the evidence regarding the benefits of early tracheostomy on the incidence of VAP and mortality remains weak.(\\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e)\\u003c/p\\u003e\\n\\u003cp\\u003eA study by Hui-Hsuan Lai, et al. (2021) reported that the decision to perform a tracheostomy did not affect the long-term survival or annual medical costs for patients on prolonged mechanical ventilation (PMV). This highlights the importance of individualized treatment planning to reduce mortality and medical expenses.(\\u003cspan class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e) Based on the various research findings above, the majority show that tracheostomy in patients requiring long-term mechanical ventilation is proven to reduce the incidence of VAP, and this result is consistent with our study\\u0026apos;s findings\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthic\\u0026nbsp;\\u003c/strong\\u003e\\u003cstrong\\u003eapproval\\u003c/strong\\u003e\\u003cstrong\\u003e:\\u0026nbsp;\\u003c/strong\\u003eEthics Commission for Biomedical Research on Humans, Faculty of Medicine, Hasanuddin University, with protocol number 523/UN4.6.4.5.31/PP36/2024.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConflict of Interest:\\u0026nbsp;\\u003c/strong\\u003eNone\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors Contribution:\\u0026nbsp;\\u003c/strong\\u003eIM (concept, design, literature search, manuscript editing, manuscript review), SPR (concept, literature search, data acquisition, data analysis, manuscript preparation), KHA (literature search, data acquisition, data analysis, manuscript editing), MFP (literature search, data acquisition, manuscript preparation, manuscript editing), AQP (data acquisition, manuscript preparation, manuscript editing)\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eDeclaration on the use of AI:\\u0026nbsp;\\u003c/strong\\u003eNone.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication:\\u0026nbsp;\\u003c/strong\\u003e\\u003cstrong\\u003eNone\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgments: None\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding: None\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eChastre J, Luyt C-E (2022) Ventilator-Associated Pneumonia. In: Broaddus C, Ernst J, King T, Lazarus S, Sarmiento K, Schnapp L et al (eds) Murray \\u0026amp; Nadel\\u0026rsquo;s textbook ofrespiratorymedicine, 7th edn. Elsevier Inc, Philadelphia\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eVincent J-L, Moore FA, Bellomo R et al (2024) Textbook of Critical Care, 8th edn. Elsevier Inc. All rights reserved\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eBassi GL, Luque N, Mart\\u0026iacute; JD et al (2015) Endotracheal tubes for critically ill patients: An in vivo analysis of associated tracheal injury, mucociliary clearance, and sealing effi cacy. Chest 147:1327\\u0026ndash;1335\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eLoscalzo J, kasper DL, Longo DL et al (2022) Harrison\\u0026rsquo;s Principles of Internal Medicine, 21st edn. McGraw Hill Education, New York NY\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMadjid AS, Sugiarto A, Putri RP et al (2015) Korelasi Modified Clinical Pulmonary Infection Score dengan Lama Ventilasi Mekanis pada Pasien dengan Pneumonia di UPI RSUPN Cipto Mangunkusumo\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eKahveci F, Emre G, Berin O, Akalin H et al (2012) Evaluation of a clinical pulmonary infection score in the diagnosis of ventilator-associated pneumonia, \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e\\u003c/span\\u003e\\u003cspan address=\\\"http://www.signavitae.com\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSafdar N, O\\u0026rsquo;Horo JC, Mak R et al Agreement between the Clinical Pulmonary Infection Score and NHSN criteria for surveillance of Ventilator Associated Pneumonia. Int J Infect Control; 9. Epub ahead of print 7 February 2013. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3396/ijic.v9i1.008.13\\u003c/span\\u003e\\u003cspan address=\\\"10.3396/ijic.v9i1.008.13\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eWilliams NS, O\\u0026rsquo;connell PR, McCaskie AW (2018) 6. Bailey \\u0026amp; Love\\u0026rsquo;s Short Practice of Surgery 27th edition, 27th edn. Taylor \\u0026amp; Francis Group, LLC\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMarra A, Vargas M, Buonanno P et al Early vs. Late tracheostomy in patients with traumatic brain injury: Systematic review and meta-analysis. Journal of Clinical Medicine; 10. 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Epub ahead of print 24 April 2023. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.7759/cureus.38062\\u003c/span\\u003e\\u003cspan address=\\\"10.7759/cureus.38062\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eBuston E, Efrizon H Relationship Of Number Of Secrets With Events Of Vap (Associated Pneumonia Ventilators) In Patients In ICU RSUD. 2020. Epub ahead of print 2020. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.37676/jnph.v8i2.1176\\u003c/span\\u003e\\u003cspan address=\\\"10.37676/jnph.v8i2.1176\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eLe Pape M, Besnard C, Acatrinei C et al Clinical impact of ventilator-associated pneumonia in patients with the acute respiratory distress syndrome: a retrospective cohort study. Ann Intensive Care; 12. 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Korean J Intern Med 40:286\\u0026ndash;298\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSwain SK, Jena PP (2021) Role of early tracheostomy for preventing ventilator associated pneumonia in intensive care unit: a review. Int J Otorhinolaryngol Head Neck Surg 7:1083\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eBesci T, Ak T, \\u0026Ouml;zdemir G et al (2023) The Effect of Tracheostomy Timing on Clinical Outcomes in Children. J Pediatr Emerg Intensive Care Medicine(Turkey) 10:111\\u0026ndash;116\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMoore AWB, Pitts L, Jasahui MP An updated review in percutaneous tracheostomy. AME Medical Journal; 9. 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Epub ahead of print 5 April 2025. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1136/bmjresp-2024-002434\\u003c/span\\u003e\\u003cspan address=\\\"10.1136/bmjresp-2024-002434\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eLai HH, Tseng PY, Wang CY et al Long-term survival and medical costs of patients with prolonged mechanical ventilation and tracheostomy: A nationwide cohort study. Int J Environ Res Public Health; 18. Epub ahead of print 1 October 2021. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3390/ijerph181910272\\u003c/span\\u003e\\u003cspan address=\\\"10.3390/ijerph181910272\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Tracheostomy, modified clinical pulmonary infection score (MCPIS), Ventilator Associated Pneumonia (VAP)\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7349120/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7349120/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground and aim\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe 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.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eUsing 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.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThere 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 \\u0026lt; 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 \\u0026lt; 0.05). In contrast, the leukocyte and chest X-ray scores showed no significant difference (all with p \\u0026gt; 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 \\u0026lt; 0.05). Meanwhile, the scores for leukocyte count, tracheal secretions, oxygenation, and chest X-ray showed no significant difference (all with p \\u0026gt; 0.05).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThere is a significant relationship between performing a tracheostomy and not performing a tracheostomy on the incidence of VAP.\\u003c/p\\u003e\",\"manuscriptTitle\":\"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\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-08-12 14:56:17\",\"doi\":\"10.21203/rs.3.rs-7349120/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"dc16ce5a-e4c8-4699-ac69-6756f3a99528\",\"owner\":[],\"postedDate\":\"August 12th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-08-29T13:09:01+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-08-12 14:56:17\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7349120\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7349120\",\"identity\":\"rs-7349120\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}