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Infection control in the intensive care unit. The role of the ventilator circuit

D Hess1

  • 1Respiratory Care, Massachusetts General Hospital, Anesthesia, Harvard Medical School Boston, MA, USA. dhess@partners.org

Minerva Anestesiologica
|May 25, 2002
PubMed

Insights

Ventilator-associated pneumonia (VAP) often stems from aspirated secretions, not inhaled pathogens. Evidence suggests changing ventilator circuits only when needed, and not daily, maintains VAP rates.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Respiratory Therapy

Background:

  • Ventilator-associated pneumonia (VAP) is a common hospital-acquired infection.
  • Current practices for VAP prevention involve frequent changes of respiratory equipment.
  • The primary source of VAP may be microaspiration of oral secretions.

Purpose of the Study:

  • To evaluate the necessity of daily changes for respiratory equipment in VAP prevention.
  • To explore alternative terminology like "airway-associated pneumonia".

Main Methods:

  • Review of existing studies on VAP rates and equipment change protocols.
  • Analysis of evidence regarding the source of pathogens in VAP.
  • Assessment of data on passive humidifiers and closed suction catheters.

Main Results:

  • Aspiration of secretions past the endotracheal tube cuff is a more significant VAP pathway than inhalation.
  • Studies show no increase in VAP rates when ventilator circuits are changed on an as-needed basis.
  • Evidence indicates passive humidifiers and closed suction catheters do not require daily replacement.

Conclusions:

  • The term "airway-associated pneumonia" may be more precise than "ventilator-associated pneumonia".
  • Optimizing ventilator circuit and component change protocols can maintain VAP rates while potentially reducing costs and waste.
  • Focusing on preventing microaspiration is crucial for VAP reduction strategies.

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