Frequency of Ventilator-associated Pneumonia With 3-day Versus 7-day Ventilator Circuit Changes
Article Outline
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
No full text is available. To read the body of this article, please view the PDF online.
References
- Prospective study of nosocomial pneumonia and of patient and circuit colonization during mechanical ventilation with circuit changes every 48 hours versus no change . Am Rev Respir Dis . 1991;143:738–743
- . Infection control in the intensive care unit: the role of the ventilator circuit . Minerva Anesthesiol . 2002;68:356–359
- . Epidemiology and risk factors for nosocomial pneumonia. Emphasis on prevention . Clin Chest Med . 1999;20:653–670
- . The prevention of ventilator-associated pneumonia . N Engl J Med . 1999;340:627–634
- . Preventing nosocomial pneumonia: state of the art and perspectives for the 1990s . Am J Med . 1991;91(3B):44S–53S
- . Risk factors for ICU-acquired pneumonia . JAMA . 1998;279:1605–1606
- NHSN Facilities. National Healthcare Safety Network (NHSN), data summary for 2006, issued June 2007 . Am J Infect Control . 2007;35:290–301
- . Pediatric Prevention Network. Nosocomial infection rates in US children's hospitals' neonatal and pediatric intensive care units . Am J Infect Control . 2001;29:152–157
- . Pediatric intensive care unit nosocomial infections: epidemiology, sources and solutions . Crit Care Clin . 2003;19:473–487
- . Biofilm formation in endotracheal tubes: association between pneumonia and the persistence of pathogens . Monaldi Arch Chest Dis . 2002;57:84–87
- . Electron microscopic evaluation of bacterial adherence to polyvinyl chloride endotracheal tubes used in neonates . Crit Care Med . 1989;17:1335–1340
- Implications of endotracheal tube biofilm for ventilator-associated pneumonia . Intensive Care Med . 1999;25:1072–1076
- . The ventilator circuit and ventilator-associated pneumonia . Respir Care . 2005;50:774–785
- . Extending ventilator circuit change interval beyond 2 days reduces the likelihood of ventilator-associated pneumonia . Chest . 1998;113:405–411
- Mechanical ventilation with or without 7-day circuit changes: a randomized controlled trial . Ann Intern Med . 1995;123:168–174
- . American Association for Respiratory Care. Care of the ventilator circuit and its relation to ventilator-associated pneumonia . Respir Care . 2003;48:869–879
- . Outcomes in post-ICU mechanical ventilation: a therapist-implemented weaning protocol . Chest . 2001;119:236–242
- . Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease: a randomized, controlled trial . Ann Intern Med . 1998;128:721–728
- . Frequency of change of ventilator circuit in premature infants: impact on ventilator-associated pneumonia . Pediatr Crit Care Med . 2001;2:127–132
- . PRISM III: an updated Pediatric Risk of Mortality Score . Crit Care Med . 1996;24:743–752
- . The National Healthcare Safety Network (NHSN): patient safety component protocol . Available at: http://www.cdc.gov/ncidod/dhqp/pdf/nhsn/NHSN_Manual_PatientSafetyProtocol_CURRENT.pdf [Date accessed: March 10, 2008]
- . Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. A consensus statement, American Thoracic Society, November 1995 . Am J Respir Crit Care Med . 1996;153:1711–1725
- 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
- . Periodically changing ventilator circuits is not necessary to prevent ventilator-associated pneumonia when a heat and moisture exchanger is used . Infect Control Hosp Epidemiol . 2004;25:1077–1082
- . Role of respiratory assistance devices in endemic nosocomial pneumonia . Am J Med . 1981;70:681–685
- . Weekly ventilator circuit changes: a strategy to reduce costs without affecting pneumonia rates . Anesthesiology . 1995;82:903–911
- . Ventilator-associated pneumonia with circuit changes every 2 days versus every week . Chin Med J (Engl) . 2001;64:161–167
- . Ventilator-associated pneumonia and frequency of circuit changes . Am J Infect Control . 1998;26:71–73
- . Guideline for prevention of nosocomial pneumonia. The Hospital Infection Control Practices Advisory Committee, Centers for Disease Control and Prevention . Infect Control Hosp Epidemiol . 1994;15:587–627
- Tailoring the Institute for Health Care Improvement 100,000 Lives Campaign to pediatric settings: the example of ventilator-associated pneumonia . Pediatr Clin North Am . 2006;53:1231–1251
- . Ventilator-associated pneumonia. Prevention, diagnosis and therapy . Crit Care Clin . 2002;18:107–125
- . Ventilator-associated pneumonia in pediatric intensive care unit patients: risk factors and outcomes . Pediatrics . 2002;109:758–764
- . Implementation of a pediatric-specific VAP bundle results in near elimination of ventilator-associated pneumonia (VAP) in a tertiary pediatric ICU . Chest . 2006;130:138S; [Abstract]
PII: S1875-9572(10)60008-3
doi:10.1016/S1875-9572(10)60008-3
© 2010 Taiwan Pediatric Association. Published by Elsevier Inc. All rights reserved.
