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Mechanical Ventilation with or without 7-Day Circuit Changes: A Randomized Controlled Trial

Marin H. Kollef; Steven D. Shapiro; Victoria J. Fraser; Patricia Silver; Denise M. Murphy; Ellen Trovillion; Mona L. Hearns; Rodger D. Richards; Lisa Cracchilo; and Linda Hossin
[+] Article, Author, and Disclosure Information

From Washington University School of Medicine, Barnes Hospital, and Jewish Hospital, St. Louis, Missouri. Requests for Reprints: Marin H. Kollef, MD, Pulmonary and Critical Care Division, Washington University School of Medicine, Box 8052, 660 South Euclid Avenue, St. Louis, MO 63110. Acknowledgments: The authors thank Daniel P. Schuster, MD, for his review of the manuscript and Darnetta M. Baker, RRT, for her personal communication.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;123(3):168-174. doi:10.7326/0003-4819-123-3-199508010-00002
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Objective: To determine whether a practice of not routinely changing ventilator circuits in patients who require prolonged mechanical ventilation is associated with an increased incidence of nosocomial pneumonia.

Design: Randomized controlled trial.

Setting: Intensive care units in two university-affiliated teaching hospitals.

Patients: 300 patients admitted to an intensive care unit who required mechanical ventilation for more than 5 days.

Intervention: Patients were randomly assigned to receive either no routine ventilator circuit changes or circuit changes every 7 days.

Measurements: The primary outcome measure was the incidence of ventilator-associated pneumonia. Other outcome measures included duration of mechanical ventilation, length of hospital stay, and hospital mortality.

Results: 147 patients were randomly assigned to receive no routine ventilator circuit changes, and 153 patients were randomly assigned to receive circuit changes every 7 days. The two groups were similar at the time of randomization with regard to demographic characteristics, intensive care unit admission diagnoses, and severity of illness. Ventilator-associated pneumonia was seen in 36 patients (24.5%) receiving no routine changes and in 44 patients (28.8%) receiving changes every 7 days (relative risk, 0.85 [95% CI, 0.55 to 1.17]). No statistically significant differences for hospital mortality, intensive care unit mortality, death during mechanical ventilation, death in patients with ventilator-associated pneumonia, or mortality directly attributed to ventilator-associated pneumonia were found between the two treatment groups (P ≥ 0.11). Patients receiving changes every 7 days had 247 circuit changes costing a total of $7410; patients receiving no routine changes had a total of 11 circuit changes costing $330.

Conclusion: The elimination of routine ventilator circuit changes can reduce medical care costs without increasing the incidence of nosocomial pneumonia in patients who require prolonged mechanical ventilation.





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