Chest
Clinical Investigations in Critical CareExtending Ventilator Circuit Change Interval Beyond 2 Days Reduces the Likelihood of Ventilator-Associated Pneumonia
Section snippets
Study Design and Patient Selection
During a 4-year period, all patients receiving mechanical ventilation in both the respiratory ICU (RICU) and the medical ICU (MICU) at Edward Hines Jr. Veterans Affairs (VA) Hospital were concurrently reviewed by an infection control practitioner to identify the presence of VAP using the 1988 CDC criteria.15
For 2 years, 1991 and 1992, mechanical ventilator circuits were changed at 2-day intervals. On January 1, 1993, a circuit change interval of 7 days was instituted for a 1-year trial period.
Results
During the 4-year study, 637 patients accounted for 753 cases receiving 7,709 days of mechanical ventilation. Fifty-two unique patients were involved with 60 incidents (9%) that met the definition as having one (or more) VAP during their mechanical ventilation. The control period, consisting of approximately 2 years, resulted in a pneumonia rate of 11.44/1,000 ventilator days for the first year and 12.3/1,000 ventilator days for the second year. During the control period, 17 patients acquired
Discussion
We found that extending ventilator circuit change intervals beyond 2 days resulted in significant reductions in both the rate and risk of VAP when compared with 2-day circuit change intervals. The difference in occurrence of VAP between 7- and 30-day intervals was not significant, while the difference in RR identified in our MICU compared with the RICU was most likely related to admission criteria for more acutely ill patients with multisystem failure in that unit. Both RICU and MICU are
ACKNOWLEDGMENT
The authors thank Mose Fisher, RRT, and Lynnel Hodge for their help with data collection.
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Supported by the Research Service of the Department of Veterans Affairs.
revision accepted September 9, 1997.