Periodic change of ventilator circuits: an unnecessary cost

Objective

To analyze the utility of periodic change of ventilator circuits (PCVC) to prevent the incidence of ventilator-associated pneumonia (VAP).

Methods

It is a prospective study. Included were all patients admitted in the ICU from 1 April 2001 until 30 September 2002 and who required mechanical ventilation for 72 hours or more. At admission to the ICU patients were randomized in two groups: one group ventilated with PCVC each 48 hours, and another one without PCVC. A throat swab on admission and afterwards twice weekly were taken. Infections were diagnosed according to CDC criteria and classified based on throat flora in endogenous and exogenous. The statistical analysis was realized by chi-square test and Student t test, and we took values P < 0.05 to consider a significant difference.

Results

Included were 304 patients (62.82% male). Mean age was 58.86 ± 18.24 years. APACHE II was 16.01 ± 7.26. Mortality was 32.23%. Both groups of patients (143 with PCVC and 161 without PCVC) were similar in age, sex, mortality and APACHE II. No significant differences were found in the percentage of patients who developed VAP (23.07% vs 22.98%), nor in the number of VAP per 1000 mechanical ventilation-days (20.27 vs 27.81). Neither in the percentage of patients who developed VAP and in the number of VAP per 1000 mechanical ventilation-days in each group of mechanical ventilation-days. Neither in the percentage of patients who developed exogenous VAP (2.79% vs 2.48%), neither in the number of exogenous VAP per 1000 mechanical ventilation-days (1.71 vs 1.09).

Conclusions

In our series, the periodic change of ventilator circuits did not reduce the incidence of VAP nor was VAP exogenous.