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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
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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

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