Medical Journal of The Islamic Republic of Iran (MJIRI)

    Background: The principal mechanism underlying the development of ventilator-associated pneumonia (VAP) involves the aspiration of microorganisms from colonized oropharyngeal secretions past the endotracheal tube (ETT), followed by bacterial proliferation along the ETT surface. The Modified Clinical Pulmonary Infection Score (MCPIS) is commonly utilised to assist in the diagnosis and clinical evaluation of pneumonia. This instrument assesses various factors, including body temperature, leukocyte count, the volume and characteristics of tracheal secretions, oxygenation status, and results from chest imaging. Airway management through ETT intubation or tracheostomy plays a crucial role in ensuring airway patency, minimizing anatomical dead space, facilitating effective suctioning, and optimizing oxygen delivery.
   Methods: This prospective cohort study included individuals diagnosed with non-traumatic brain damage, selected using successive sampling according to established inclusion and exclusion criteria. The sample size was established at a 90% confidence level and a precision of 20%, with statistical significance defined at p < 0.05. The research was carried out at Wahidin Sudirohusodo Hospital in Makassar, from March 2024 to April 2025, and involved evaluating the MCPIS both before and after tracheostomy, as well as in patients who did not undergo the procedure. Data analysis was conducted using SPSS version 25, applying the Wilcoxon Signed-Rank test to assess statistical differences.
   Results: A total of 50 samples were included (25 with tracheostomy and 25 without). When the average MCPIS scores were analyzed, the tracheostomy group's score dropped from 4.92 to 3.20 (P=0.001), a statistically significant drop. On the other hand, MCPIS scores in the non-tracheostomy group increased from 5.04 to 5.60, although this difference was not statistically significant (P=0.158). Within the tracheostomy cohort, significant improvements were noted in the subcomponents of body temperature (P=0.009), tracheal secretion characteristics (P=0.003), and oxygenation status (P= 0.046). However, no meaningful changes were detected in the parameters of leukocyte count (P=0.564) and chest radiographic findings (P=0.222).
   Conclusion: Tracheostomy was associated with improved MCPIS outcomes compared to non-tracheostomy, particularly in the components of temperature, tracheal secretion, and oxygenation.