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Volume 51, Issue 1, Pages 37-43 (February 2010)


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

Ting-Chang Hsieha, Shao-Hsuan HsiabCorresponding Author Informationemail address, Chang-Teng Wub, Tzou-Yien Linc, Chih-Ching Changd, Kin-Sun Wonge

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.

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1. 1 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 48 hours versus no change . Am Rev Respir Dis . 1991;143:738–743 . MEDLINE

2. 2 Hess D . Infection control in the intensive care unit: the role of the ventilator circuit . Minerva Anesthesiol . 2002;68:356–359 .

3. 3 Kollef MH . Epidemiology and risk factors for nosocomial pneumonia. Emphasis on prevention . Clin Chest Med . 1999;20:653–670 . MEDLINE | CrossRef

4. 4 Kollef MH . The prevention of ventilator-associated pneumonia . N Engl J Med . 1999;340:627–634 . MEDLINE | CrossRef

5. 5 Craven DE , Steger KA , Barber TW . Preventing nosocomial pneumonia: state of the art and perspectives for the 1990s . Am J Med . 1991;91(3B):44S–53S . MEDLINE

6. 6 Cook DJ , Kollef MH . Risk factors for ICU-acquired pneumonia . JAMA . 1998;279:1605–1606 . MEDLINE | CrossRef

7. 7 Edwards JR , Peterson KD , Andrus ML , et al.   NHSN Facilities. National Healthcare Safety Network (NHSN), data summary for 2006, issued June 2007 . Am J Infect Control . 2007;35:290–301 . Full Text | Full-Text PDF (150 KB)

8. 8 Stover BH , Shulman ST , Bratcher DF , Brady MT , Levine GL , Jarvis WR . 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 . Abstract | Full Text | Full-Text PDF (94 KB) | CrossRef

9. 9 Rowin ME , Patel VV , Christenson JC . Pediatric intensive care unit nosocomial infections: epidemiology, sources and solutions . Crit Care Clin . 2003;19:473–487 . Full Text | Full-Text PDF (120 KB) | CrossRef

10. 10 Bauer TT , Torres A , Ferrer R , Heyer CM , Schultze-Werninghaus G , Rasche K . Biofilm formation in endotracheal tubes: association between pneumonia and the persistence of pathogens . Monaldi Arch Chest Dis . 2002;57:84–87 . MEDLINE

11. 11 Diaz-Blanco J , Clawson RC , Roberson SM , Sanders CB , Pramanik AK , Herbst JJ . Electron microscopic evaluation of bacterial adherence to polyvinyl chloride endotracheal tubes used in neonates . Crit Care Med . 1989;17:1335–1340 . MEDLINE

12. 12 Adair CG , Gorman SP , Feron BM , et al.   Implications of endotracheal tube biofilm for ventilator-associated pneumonia . Intensive Care Med . 1999;25:1072–1076 . MEDLINE | CrossRef

13. 13 Branson RD . The ventilator circuit and ventilator-associated pneumonia . Respir Care . 2005;50:774–785 . MEDLINE

14. 14 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 . MEDLINE | CrossRef

15. 15 Kollef MH , Shapiro SD , Fraser VJ , et al.   Mechanical ventilation with or without 7-day circuit changes: a randomized controlled trial . Ann Intern Med . 1995;123:168–174 . MEDLINE

16. 16 Hess DR , Kallstrom TJ , Mottram CD , Myers TR , Sorenson HM , Vines DL . American Association for Respiratory Care. Care of the ventilator circuit and its relation to ventilator-associated pneumonia . Respir Care . 2003;48:869–879 . MEDLINE

17. 17 Scheinhorn DJ , Chao DC , Stearn-Hassenpflug M , Wallace WA . Outcomes in post-ICU mechanical ventilation: a therapist-implemented weaning protocol . Chest . 2001;119:236–242 . MEDLINE | CrossRef

18. 18 Nava S , Ambrosino N , Clini E , Prato M , Orlando G , Vitacca M . 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 . MEDLINE

19. 19 Makhoul IR , Kassis I , Berant M , Hashman N , Revach M , Sujov P . Frequency of change of ventilator circuit in premature infants: impact on ventilator-associated pneumonia . Pediatr Crit Care Med . 2001;2:127–132 . CrossRef

20. 20 Pollack MM , Ruttimann UE , Getson PR . PRISM III: an updated Pediatric Risk of Mortality Score . Crit Care Med . 1996;24:743–752 . MEDLINE | CrossRef

21. 21 Centers for Disease Control and Prevention/Division of Quality Healthcare Promotion  . 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] .

22. 22 American Thoracic Society  . 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 .

23. 23 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 . MEDLINE

24. 24 Lorente L , Lecuona M , Galván R , Ramos MJ , Mora ML , Sierra A . 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 . CrossRef

25. 25 Cross AS , Roup B . Role of respiratory assistance devices in endemic nosocomial pneumonia . Am J Med . 1981;70:681–685 . Abstract | Full-Text PDF (573 KB) | CrossRef

26. 26 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 . MEDLINE | CrossRef

27. 27 Lien TC , Lin MY , Chu CC , Kuo BI , Wang ED , Wang JH . Ventilator-associated pneumonia with circuit changes every 2 days versus every week . Chin Med J (Engl) . 2001;64:161–167 .

28. 28 Stamm AM . Ventilator-associated pneumonia and frequency of circuit changes . Am J Infect Control . 1998;26:71–73 . Abstract | Full Text | Full-Text PDF (65 KB) | CrossRef

29. 29 Tablan OC , Anderson LJ , Arden NH , Breiman RF , Butler JC , McNeil MM . 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 .

30. 30 Curley MA , Schwalenstocker E , Deshpande JK , et al.   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 . Full Text | Full-Text PDF (344 KB) | CrossRef

31. 31 Keenan SP , Heyland DK , Jacka MJ , Cook D , Dodek P . Ventilator-associated pneumonia. Prevention, diagnosis and therapy . Crit Care Clin . 2002;18:107–125 . Abstract | Full Text | Full-Text PDF (150 KB) | CrossRef

32. 32 Edwards AM , Warren DK , Fraser VJ . Ventilator-associated pneumonia in pediatric intensive care unit patients: risk factors and outcomes . Pediatrics . 2002;109:758–764 .

33. 33 Brilli RJ , Wells D , Shaw J . 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] .

a Division of Pediatrics, Far-Eastern Memorial Hospital, Taipei, Taiwan

b Division of Pediatric Critical Care and Emergency Medicine, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan

c Division of Pediatric Infectious Diseases, Chang Gung Children's Hospital, Taoyuan, Taiwan

d Department of Respiratory Therapy, Chang Gung Children's Hospital, Taoyuan, Taiwan

e Division of Pediatric Pulmonology, Chang Gung Children's Hospital, 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

PII: S1875-9572(10)60008-3

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


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