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Prospective, randomized study of ventilator-associated pneumonia in patients with one versus three ventilator circuit

M N Long1, G Wickstrom, A Grimes

  • 1Department of Medicine, University of Alabama Hospital, Birmingham 35294, USA.

Infection Control and Hospital Epidemiology
|January 1, 1996
PubMed
Abstract

Insights

Reducing ventilator circuit changes to once weekly did not increase ventilator-associated pneumonia (VAP) rates overall. This change may decrease VAP in short-term ventilated patients but potentially increase it in longer-term cases.

Area of Science:

  • Critical Care Medicine
  • Infectious Disease Prevention
  • Hospital-Acquired Infections

Background:

  • Ventilator-associated pneumonia (VAP) is a significant concern in intensive care units.
  • Current guidelines often recommend frequent changes of ventilator circuits.

Purpose of the Study:

  • To evaluate the impact of reducing ventilator circuit changes from thrice weekly to once weekly on VAP rates.

Main Methods:

  • A prospective, randomized trial was conducted in medical and neurosciences intensive care units.
  • 447 mechanically ventilated patients were randomized to circuit changes three times/week or once/week.
  • VAP surveillance followed National Nosocomial Infections Surveillance System methods.

Main Results:

  • No significant difference in overall VAP rates between groups (MICU: 7.3 vs 5.9; NICU: 12.2 vs 12.6 per 1,000 ventilator days).
  • For patients ventilated ≤7 days, VAP rates were lower with once-weekly changes (5.9 vs 9.0 per 1,000 ventilator days).
  • For patients ventilated >7 days, VAP rates were higher with once-weekly changes (13.2 vs 9.6 per 1,000 ventilator days).

Conclusions:

  • Decreasing ventilator circuit changes to once weekly did not adversely affect overall VAP rates.
  • Less frequent changes may reduce VAP in patients ventilated for ≤1 week.
  • Increased VAP incidence may occur in patients ventilated >1 week with less frequent circuit changes.

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