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Updated: Jul 5, 2026
Mechanical Ventilation Boot Camp Curriculum
Published on: March 12, 2018
Mechanical ventilation with or without 7-day circuit changes. A randomized controlled trial
M H Kollef1, S D Shapiro, V J Fraser
1Pulmonary and Critical Care Division, Washington University School of Medicine, St. Louis, MO 63110, USA.
Objective:
To determine whether a practice of not routinely changing ventilator circuits in patients who require prolonged mechanical ventilation is associated with an increased incidence of nosocomial pneumonia.
Design:
Randomized controlled trial.
Setting:
Intensive care units in two university-affiliated teaching hospitals.
Patients:
300 patients admitted to an intensive care unit who required mechanical ventilation for more than 5 days.
Intervention:
Patients were randomly assigned to receive either no routine ventilator circuit changes or circuit changes every 7 days.
Measurements:
The primary outcome measure was the incidence of ventilator-associated pneumonia. Other outcome measures included duration of mechanical ventilation, length of hospital stay, and hospital mortality.
Results:
147 patients were randomly assigned to receive no routine ventilator circuit changes, and 153 patients were randomly assigned to receive circuit changes every 7 days. The two groups were similar at the time of randomization with regard to demographic characteristics, intensive care unit admission diagnoses, and severity of illness. Ventilator-associated pneumonia was seen in 36 patients (24.5%) receiving no routine changes and in 44 patients (28.8%) receiving changes every 7 days (relative risk, 0.85 [95% CI, 0.55 to 1.17]). No statistically significant differences for hospital mortality, intensive care unit mortality, death during mechanical ventilation, death in patients with ventilator-associated pneumonia, or mortality directly attributed to ventilator-associated pneumonia were found between the two treatment groups (P > or = 0.11). Patients receiving changes every 7 days had 247 circuit changes costing a total of $7410; patients receiving no routine changes had a total of 11 circuit changes costing $330.
Conclusion:
The elimination of routine ventilator circuit changes can reduce medical care costs without increasing the incidence of nosocomial pneumonia in patients who require prolonged mechanical ventilation.
Insights
Eliminating routine ventilator circuit changes in prolonged mechanical ventilation patients does not increase pneumonia rates. This practice significantly reduces healthcare costs without compromising patient safety.
Area of Science:
- Critical Care Medicine
- Infectious Disease Prevention
- Healthcare Economics
Background:
- Nosocomial pneumonia is a significant complication in patients requiring prolonged mechanical ventilation.
- Routine changes of ventilator circuits are a common but costly practice aimed at preventing such infections.
Purpose of the Study:
- To evaluate if foregoing routine ventilator circuit changes impacts the incidence of nosocomial pneumonia in critically ill patients.
- To assess the economic implications of altering ventilator circuit change protocols.
Main Methods:
- A randomized controlled trial was conducted in intensive care units involving 300 patients needing mechanical ventilation for over 5 days.
- Patients were randomized to either no routine circuit changes or changes every 7 days.
- The primary outcome was ventilator-associated pneumonia incidence, with secondary outcomes including mortality and length of stay.
Main Results:
- The incidence of ventilator-associated pneumonia was similar between groups (24.5% vs. 28.8%), with no statistically significant difference (RR, 0.85; 95% CI, 0.55 to 1.17).
- No significant differences were observed in hospital mortality, ICU mortality, or mortality attributed to ventilator-associated pneumonia.
- The group with no routine changes incurred substantially lower costs ($330 vs. $7410) due to fewer circuit changes.
Conclusions:
- Eliminating routine ventilator circuit changes is a safe strategy for patients on prolonged mechanical ventilation.
- This practice can lead to significant reductions in healthcare expenditures without adversely affecting patient outcomes or increasing pneumonia risk.
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