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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Tracheostomy and Ventilator-Associated Pneumonia in Mechanically Ventilated ICU Patients: A Retrospective Matched Cohort Study

by
Marie Nicoline Ordaz-Kücks
1,
Iván Alejandro Arteaga-Martínez
2,
Hugo Alfredo Funes-González
1,
Fernando Martín Guerra-Infante
3,
Roberto Montes-de-Oca-Jiménez
4,5,
Martha Elba Ruiz-Riva-Palacio
5,
Javier Morales-Fabian
1,
Enrique Rojano-Lastra
1,
Heberto Hernández-Miranda
1,
José Carlos Aguilar-Carrasco
6,* and
Gabriel Arteaga-Troncoso
6,*
1
Programa Académico de la Especialidad en Epidemiología, Hospital General “Dra. Matilde Petra Montoya Lafragua”, Ciudad de México 13260, Mexico
2
Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México 11340, Mexico
3
Departamento de Fisiología y Desarrollo Celular, Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Ciudad de México 11000, Mexico
4
Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma del Estado de México, Toluca 56200, Estado de México, Mexico
5
Plantel Sor Juana Inés de la Cruz, Universidad Autónoma del Estado de México, Amecameca 56900, Estado de México, Mexico
6
Laboratorio de Farmacología Experimental, Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Ciudad de México 11000, Mexico
*
Authors to whom correspondence should be addressed.
J. Clin. Med. 2026, 15(12), 4811; https://doi.org/10.3390/jcm15124811 (registering DOI)
Submission received: 14 May 2026 / Revised: 11 June 2026 / Accepted: 18 June 2026 / Published: 21 June 2026
(This article belongs to the Special Issue Advancing Mechanical Ventilation in Critical Care: From Clinical Foundations to Personalized Strategies)
Versions Notes

Abstract

Background/Objectives: Ventilator-associated pneumonia (VAP) remains a major complication in patients requiring prolonged mechanical ventilation. The effect of tracheostomy on VAP risk remains controversial, particularly when differences in duration of mechanical ventilation are considered. This study evaluated the association between tracheostomy, VAP occurrence, and clinical outcomes in mechanically ventilated ICU patients. Methods: We conducted a retrospective matched exposed–unexposed cohort study in a tertiary-care ICU in Mexico City. Patients undergoing tracheostomy were compared with an age- and sex-matched subcohort of intubated patients receiving invasive mechanical ventilation for ≥48 h. VAP incidence was assessed using cumulative incidence, incidence density, and multivariable generalized linear models. Results: A total of 218 patients were included (55 tracheostomized and 163 intubated). VAP incidence density was similar between groups (31.5 vs. 30.3 per 1000 ventilator-days; RR 1.04, 95% CI 0.7–1.7), whereas cumulative incidence was higher among tracheostomized patients (61.8% vs. 22.7%; RR 2.7, 95% CI 1.9–3.9). Broad-spectrum antibiotics, mechanical ventilation ≥ 5 days, chronic pulmonary disease, and ICU stay remained associated with VAP occurrence in an exploratory multivariable model. Gram-negative microorganisms predominated, and antimicrobial resistance was more frequent among tracheostomized patients. Conclusions: Tracheostomy was associated with higher cumulative incidence of VAP, but a similar incidence density compared with endotracheal intubation. The crude association between tracheostomy and VAP disappeared after adjustment for confounding factors, suggesting that prolonged mechanical ventilation and ICU exposure are more important determinants of VAP risk than tracheostomy itself.
Keywords: ventilator-associated pneumonia; tracheostomy; mechanical ventilation; intensive care units; retrospective matched cohort study; antimicrobial resistance; Gram-negative pathogens; critical care ventilator-associated pneumonia; tracheostomy; mechanical ventilation; intensive care units; retrospective matched cohort study; antimicrobial resistance; Gram-negative pathogens; critical care

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MDPI and ACS Style

Ordaz-Kücks, M.N.; Arteaga-Martínez, I.A.; Funes-González, H.A.; Guerra-Infante, F.M.; Montes-de-Oca-Jiménez, R.; Ruiz-Riva-Palacio, M.E.; Morales-Fabian, J.; Rojano-Lastra, E.; Hernández-Miranda, H.; Aguilar-Carrasco, J.C.; et al. Tracheostomy and Ventilator-Associated Pneumonia in Mechanically Ventilated ICU Patients: A Retrospective Matched Cohort Study. J. Clin. Med. 2026, 15, 4811. https://doi.org/10.3390/jcm15124811

AMA Style

Ordaz-Kücks MN, Arteaga-Martínez IA, Funes-González HA, Guerra-Infante FM, Montes-de-Oca-Jiménez R, Ruiz-Riva-Palacio ME, Morales-Fabian J, Rojano-Lastra E, Hernández-Miranda H, Aguilar-Carrasco JC, et al. Tracheostomy and Ventilator-Associated Pneumonia in Mechanically Ventilated ICU Patients: A Retrospective Matched Cohort Study. Journal of Clinical Medicine. 2026; 15(12):4811. https://doi.org/10.3390/jcm15124811

Chicago/Turabian Style

Ordaz-Kücks, Marie Nicoline, Iván Alejandro Arteaga-Martínez, Hugo Alfredo Funes-González, Fernando Martín Guerra-Infante, Roberto Montes-de-Oca-Jiménez, Martha Elba Ruiz-Riva-Palacio, Javier Morales-Fabian, Enrique Rojano-Lastra, Heberto Hernández-Miranda, José Carlos Aguilar-Carrasco, and et al. 2026. "Tracheostomy and Ventilator-Associated Pneumonia in Mechanically Ventilated ICU Patients: A Retrospective Matched Cohort Study" Journal of Clinical Medicine 15, no. 12: 4811. https://doi.org/10.3390/jcm15124811

APA Style

Ordaz-Kücks, M. N., Arteaga-Martínez, I. A., Funes-González, H. A., Guerra-Infante, F. M., Montes-de-Oca-Jiménez, R., Ruiz-Riva-Palacio, M. E., Morales-Fabian, J., Rojano-Lastra, E., Hernández-Miranda, H., Aguilar-Carrasco, J. C., & Arteaga-Troncoso, G. (2026). Tracheostomy and Ventilator-Associated Pneumonia in Mechanically Ventilated ICU Patients: A Retrospective Matched Cohort Study. Journal of Clinical Medicine, 15(12), 4811. https://doi.org/10.3390/jcm15124811

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