Pediatrics & Neonatology
Volume 51, Issue 1 , Pages 37-43, February 2010

Frequency of Ventilator-associated Pneumonia With 3-day Versus 7-day Ventilator Circuit Changes

  • Ting-Chang Hsieh

      Affiliations

    • Division of Pediatrics, Far-Eastern Memorial Hospital, Taipei, Taiwan
    • ,
  • Shao-Hsuan Hsia

      Affiliations

    • Division of Pediatric Critical Care and Emergency Medicine, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
    • Corresponding Author InformationCorresponding author. Division of Pediatric Critical Care and Emergency Medicine, 2L PICU, Chang Gung Children's Hospital, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Kweishan, Taoyuan 33305, Taiwan
    • ,
  • Chang-Teng Wu

      Affiliations

    • Division of Pediatric Critical Care and Emergency Medicine, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
    • ,
  • Tzou-Yien Lin

      Affiliations

    • Division of Pediatric Infectious Diseases, Chang Gung Children's Hospital, Taoyuan, Taiwan
    • ,
  • Chih-Ching Chang

      Affiliations

    • Department of Respiratory Therapy, Chang Gung Children's Hospital, Taoyuan, Taiwan
    • ,
  • Kin-Sun Wong

      Affiliations

    • Division of Pediatric Pulmonology, Chang Gung Children's Hospital, Taoyuan, Taiwan

Received 27 February 2009; received in revised form 3 June 2009; accepted 22 June 2009.

Background

Ventilator-associated pneumonia (VAP) is a common clinical problem. Previous studies involving adult patient cohorts have assessed various risk factors associated with VAP, including ventilator circuit changes. The objective of this study was to examine the incidence of and risk factors associated with VAP, particularly 3-day versus 7-day ventilator circuit changes, in a pediatric intensive care unit (PICU).

Methods

This was a cohort observational study. Patients hospitalized in the PICU at Chang Gung Children's Hospital between November 2003 and September 2004 were enrolled. Investigators and critical-care specialists evaluated baseline characteristics, incidence of VAP, and related variables from PICU admission until discharge or death.

Results

Of 397 patients initially enrolled, 96 (aged 11–60 months) were available for statistical analysis and were assigned into two groups according to timing of ventilator circuit change: 3-day (n = 46) and 7-day circuit change (n = 50). No statistically significant differences were observed for VAP incidence (13% vs. 16%, p = 0.68) or hospital mortality (22% vs. 36%, p = 0.14) for 3-day versus 7-day circuit change. Incidence of VAP per 1000 ventilation days was 10.75 and 8.41 for 3-day and 7-day circuit change, respectively. Univariate analysis indicated statistical significance for the duration of mechanical ventilation (10.17 ± 16.63 days vs. 18.20 ± 14.99 days, p< 0.001), length of stay in PICU (22.30 ± 20.48 days vs. 37.22 ± 36.79 days, p= 0.0069) and presence of enteral nutrition [7 (15.22%) vs. 23 (46.0%), p = 0.0012].

Conclusion

Weekly circuit change does not contribute to increased rates of VAP in pediatric patients. Long-term studies evaluating risk factors in larger pediatric patient populations are warranted for further conclusive recommendations.

Key Words:  hospital-acquired pneumonia , nosocomial pneumonia , ventilator-associated pneumonia , ventilator circuit , ventilator circuit change

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PII: S1875-9572(10)60008-3

doi:10.1016/S1875-9572(10)60008-3

Pediatrics & Neonatology
Volume 51, Issue 1 , Pages 37-43, February 2010

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