title: Mechanical ventilation with or without daily changes of in-line suction catheters.
abstract: The purpose of this study was to determine the safety and cost-effectiveness of not routinely changing in-line suction catheters for patients requiring mechanical ventilation. Patients were randomly assigned to receive either no routine in-line suction catheter changes (n = 258) or in-line suction catheter changes every 24 h (n = 263). The main outcome measure was the incidence of ventilator-associated pneumonia. Other outcomes evaluated included hospital mortality, acquired organ system derangements, duration of mechanical ventilation, lengths of intensive care and hospital stay, and the cost for in-line suction catheters. Ventilator-associated pneumonia was seen in 38 patients (14.7%) receiving no routine in-line suction catheter changes and in 39 patients (14.8%) receiving in-line suction catheter changes every 24 h (relative risk, 0.99; 95% CI, 0.66 to 1.50). No statistically significant differences for hospital mortality, lengths of stay, the number of acquired organ system derangements, death in patients with ventilator-associated pneumonia, or mortality directly attributed to ventilator-associated pneumonia were found between the two treatment groups. Patients receiving in-line suction catheter changes every 24 h had 1,224 catheter changes costing a total of $11,016; patients receiving no routine in-line suction catheter changes had a total of 93 catheter changes costing $837. Our findings suggest that the elimination of routine in-line suction catheter changes is safe and can reduce the costs associated with providing mechanical ventilation.
authors.affiliation: Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Kollef
authors.forename: D
authors.initials: D
authors.lastname: Prentice
authors.forename: S D
authors.initials: SD
authors.lastname: Shapiro
authors.forename: V J
authors.initials: VJ
authors.lastname: Fraser
authors.forename: P
authors.initials: P
authors.lastname: Silver
authors.forename: E
authors.initials: E
authors.lastname: Trovillion
authors.forename: P
authors.initials: P
authors.lastname: Weilitz
authors.forename: B
authors.initials: B
authors.lastname: von Harz
authors.forename: R
authors.initials: R
authors.lastname: St John
mesh_terms: D000328:Adult; D000368:Aged; D002404:Catheterization / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation* / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D013396:Suction / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000706:statistics & numerical data; D013997:Time Factors