Hostname: page-component-745bb68f8f-grxwn Total loading time: 0 Render date: 2025-01-08T10:58:49.408Z Has data issue: false hasContentIssue false
  • English
  • Français

Periodically Changing Ventilator Circuits Is Not Necessary to Prevent Ventilator-Associated Pneumonia When a Heat and Moisture Exchanger Is Used

Published online by Cambridge University Press:  02 January 2015

Leonardo Lorente ,
María Lecuona ,
Ramón Galván ,
María J. Ramos ,
María L. Mora  and
Antonio Sierra
Leonardo Lorente*
Affiliation:
Department of Critical Care, Hospital Universitario de Canarias, La Laguna, Spain
María Lecuona
Affiliation:
Department of Microbiology, Hospital Universitario de Canarias, La Laguna, Spain
Ramón Galván
Affiliation:
Department of Critical Care, Hospital Universitario de Canarias, La Laguna, Spain
María J. Ramos
Affiliation:
Department of Microbiology, Hospital Universitario de Canarias, La Laguna, Spain
María L. Mora
Affiliation:
Department of Critical Care, Hospital Universitario de Canarias, La Laguna, Spain
Antonio Sierra
Affiliation:
Department of Microbiology, Hospital Universitario de Canarias, La Laguna, Spain
*
Department of Critical Care, Hospital Universitario de Canarias, Ofra s/n. La Cuesta, La Laguna 38320, Santa Cruz de Tenerife, Spain
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To analyze the efficacy of periodically changing ventilator circuits for decreasing the rate of ventilator-associated pneumonia when a heat and moisture exchanger (HME) is used for humidification. The Centers for Disease Control and Prevention recommended not changing the circuits periodically.

Design:

Randomized, controlled trial conducted between April 2001 and August 2002.

Setting:

A 24-bed, medical–surgical intensive care unit in a 650-bed, tertiary-care hospital.

Patients:

All patients requiring mechanical ventilation during more than 72 hours from April 2001 to August 2002.

Interventions:

Patients were randomized into two groups: (1) ventilation with change of ventilator circuits every 48 hours and (2) ventilation with no change of circuits. Throat swabs were taken on admission and twice weekly until discharge to classify pneumonia as endogenous or exogenous.

Results:

Three hundred four patients (143 from group 1 and 161 from group 2) with similar characteristics (age, gender, Acute Physiology and Chronic Health Evaluation II score, diagnostic group, and mortality) were analyzed. There was no significant difference in the rate of pneumonia between the groups (23.1% vs 23.0% and 15.5 vs 14.8 per 1,000 ventilator-days). There was no significant difference in the incidence of exogenous pneumonia per 1,000 days of mechanical ventilation (1.71 vs 1.25). There was no difference in the distribution of microorganisms causing pneumonia.

Conclusions:

Circuit change using an HME for humidification does not decrease pneumonia and represents an unnecessary cost.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 12 , December 2004 , pp. 1077 - 1082
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Chastre, J, Fagon, JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002;165:867–903.Google Scholar
2.Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP. Nosocomial infections in medical intensive care units in the United States: National Nosocomial Infections Surveillance System. Crit Care Med 1999;27:887–892.Google Scholar
3.Heyland, DK, Cook, DJ, Griffith, L, Keenan, SP, Brun-Buisson, C. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient: the Canadian Critical Trial Group. Am J Respir Crit Care Med 1999;159:1249–1256.Google Scholar
4.Craig, CP, Connelly, S. Effect of intensive care unit nosocomial pneumonia on duration of stay and mortality. Am J Infect Control 1984;12:233–238.Google Scholar
5.Jiménez, P, Torres, A, Rodríguez, RR, De la Bellacasa, JP, Aznar, R, Gatell, JM. Incidence and etiology of pneumonia acquired during mechanical ventilation. Crit Care Med 1989;17:882–885.Google Scholar
6.Fagon, JY, Chastre, J, Hance, AJ, Montravers, P, Novara, A, Gibert, C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 1993;94:281–288.CrossRefGoogle ScholarPubMed
7.Bercault, N, Boulain, N. Mortality rate attributable to ventilator-associated nosocomial pneumonia in an adult intensive care unit: a prospective case-control study. Crit Care Med 2001;29:2303–2309.Google Scholar
8.Joseph, JM. Disease transmission by inefficiently sanitized anesthetizing apparatus. JAMA 1952;149:1196–1198.Google Scholar
9.Craven, DE, Goularte, TA, Make, BJ. Contaminated condensate in mechanical ventilator circuits: a risk factor for nosocomial pneumonia? Am Rev Respir Dis 1984;129:625–628.Google Scholar
10.Centers for Disease Control. Guidelines for prevention of nosocomial pneumonia. Am J Infect Control 1983;11:230–244.Google Scholar
11.Centers for Disease Control and Prevention. Guidelines for prevention of nosocomial pneumonia. Am J Infect Control 1994;22:247–292.Google Scholar
12.Lien, TC, Lin, MY, Chu, CC, Kuo, BI, Wang, ED, Wang, JH. Ventilator-associated pneumonia with circuit changes every 2 days versus every week. Zhonghua Yi Xue Za Zhi 2001;64:161–167.Google Scholar
13.Long, MN, Wickstrom, G, Grimes, A, Benton, CF, Belcher, B, Stamm, AM. Prospective, randomized study of ventilator associated pneumonia in patients with one versus three ventilator circuit changes per week. Infect Control Hosp Epidemiol 1996;17:14–19.CrossRefGoogle ScholarPubMed
14.Tyra, JA, Norwood, JW. A two year experience with ten day ventilator circuit change outs. Respir Care 1994;39:5.Google Scholar
15.Salyer, JW. The effect of 7 day circuit changes on lower respiratory tract infection rates in the NICU and PICU. Respir Care 1994;39:207.Google Scholar
16.Orens, D, Stoller, JK. The impact of changing ventilator circuits at 72 hours vs 7 days on ventilator associated pneumonia. Respir Care 1994;39:171.Google Scholar
17.Hess, D, Burns, E, Romagnoli, D, Kacmarek, RM. Weekly ventilator circuit changes: a strategy to reduce costs without affecting pneumonia rates. Anesthesiology 1995;82:903–911.Google Scholar
18.Kotilainen, HR, Keroac, MA. Cost analysis and clinical impact of weekly ventilator circuit changes in patients in the intensive care unit. Am J Infect Control 1997;25:117–120.Google Scholar
19.Verri, M, Capuzzo, M, Rossi, MR, Alvisi, R, Ragazzi, R, Gritti, G. Respiratory circuits and infections of the airway. Minerva Anestesiol 1997;63:327–335.Google Scholar
20.Kollef, MH, Shapiro, SD, Fraser, VJ, et al.Mechanical ventilation with or without 7-day circuit changes. Ann Intern Med 1995;123:168–174.Google Scholar
21.Fink, JB, Krause, SA, Barrett, L, Schaaff, D, Alex, CG. Extending ventilator circuit change interval beyond 2 days reduces the likelihood of ventilator-associated pneumonia. Chest 1998;113:405–411.Google Scholar
22.Han, JN, Liu, YP, Ma, S, et al.Effects of decreasing the frequency of ventilator circuit changes to every 7 days on the rate of ventilator-associated pneumonia in a Beijing hospital. Respir Care 2001;46:891–896.Google Scholar
23.Alfredson, T, Earl, A, Larson, R, et al.Effect of extending ventilator circuit changes from 2 to 7 days. Respir Care 1994;39:161.Google Scholar
24.Krause, S, Fisher, M, Fink, J. Reduction of ventilator associated pneumonias with seven day circuit changes. Respir Care 1994;39:164.Google Scholar
25.Goodhart, G, Gilliam, C. Developing a program for monitoring ventilator associated nosocomial infections. Respir Care 1994;39:90.Google Scholar
26.Gastmeier, P, Wendt, C, Ruden, H. Breathing circuit exchange in intensive care: once daily or once weekly? Anaesthesist 1997;46:943–948.Google Scholar
27.Craven, DE, Connolly, MG, Lichtenberg, DA, Primeau, PJ, McCabe, WR. Contamination of mechanical ventilators with tubing changes every 24 or 48 hours. N Engl J Med 1982;306:1505–1509.Google Scholar
28.Dreyfuss, D, Djedaini, K, Weber, P, et al.Prospective study of nosocomial pneumonia and of patient and circuit colonization during mechanical ventilation with circuit changes every 8 hours versus no change. Am Rev Respir Dis 1991;143:738–743.Google Scholar
29.Van Saene, HKF, Damjanovic, V, Murray, AE, de la Cal, MA. How to classify infections in intensive care units: the carrier state, a criterion whose time has come? J Hosp Infect 1996;33:1–12.Google Scholar
30.Olds, JW, Kisch, AL, Eberle, BJ, Wilson, JN. Pseudomonas aeruginosa respiratory tract infection acquired from a contaminated anesthesia machine. American Review of Respiratory Disease 1972;105:628–632.Google Scholar
31.Phillips, I, Spencer, G. Pseudomonas aeruginosa cross-infection due to contaminated respiratory apparatus. Lancet 1965;2:1325–1327.Google Scholar
32.Tinne, JE, Gordon, AM, Bain, WH, Mackey, WA. Cross infection by Pseudomonas aeruginosa as a hazard of intensive surgery. Br Med J 1967;4:313–315.Google Scholar
33.Joseph, JM. Disease transmission by inefficiently sanitized anesthetizing apparatus. JAMA 1952;149:1196–1198.Google Scholar
34.Beck, A, Zadeh, JA. Infection by anaesthetic apparatus. Lancet 1968;1:533–534.Google Scholar
35.Lareau, SC, Ryan, KJ, Diener, CF. The relationship between frequency of ventilator circuit changes and infectious hazard. Am Rev Respir Dis 1978;118:493–496.Google Scholar
36.Craven, DE, Kunches, LM, Kilinsky, V, et al.Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis 1986;133:792–796.Google Scholar