title: Ventilator circuit and secretion management strategies: a Franco-Canadian survey.
abstract: OBJECTIVE
  To determine the use of ventilator circuit and secretion management strategies in France and Canada.
  
  
  METHODS
  Binational cross-sectional survey.
  
  
  METHODS
  Intensive care unit (ICU) directors in French and Canadian university hospitals.
  
  
  METHODS
  We compared responses between countries regarding the use of seven circuit and secretion strategies, the rationales against their use, decisional responsibility for these strategies, whether ventilator-associated pneumonia (VAP) practice was audited, and whether VAP prevention guidelines addressing these strategies were used.
  
  
  RESULTS
  The response rate was 72/84 (85.7%) for French and 31/32 (96.9%) for Canadian ICUs. Endotracheal intubation was predominantly oral in both countries. Changing the ventilator circuits only for every new patient was more frequent in France than in Canada (p < .0001). Heated humidifiers were used more in Canada than France (p = .0003). Closed endotracheal suctioning was used more frequently in Canada (p < .0001). In both countries, subglottic secretion drainage and kinetic beds were rarely used. Semirecumbent positioning was reported more often by French than Canadian ICUs (p = .003). Reasons for nonuse of these strategies included adverse effects (heat and moisture exchangers), cost (kinetic beds), lack of convincing benefit (subglottic secretion drainage), and nurse inconvenience (semirecumbency). Decisional responsibility for each strategy differed among institutions. VAP prevention practice was periodically reviewed in 53% of French and 68% of Canadian ICUs (p = .20). VAP prevention guidelines were used in 64% and 30% of these ICUs, respectively (p = .002).
  
  
  CONCLUSIONS
  Our study does not support the notion that published recommendations substantially impact reported use of several ventilator circuit and secretion management strategies. Based on the use of more frequent ventilator circuit changes, closed suctioning systems, heated humidifiers, and respiratory therapists, ventilator circuit and secretion management practice appears more costly in Canada than in France.
authors.affiliation: Department of Medicine, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Cook
authors.forename: J D
authors.initials: JD
authors.lastname: Ricard
authors.forename: B
authors.initials: B
authors.lastname: Reeve
authors.forename: J
authors.initials: J
authors.lastname: Randall
authors.forename: M
authors.initials: M
authors.lastname: Wigg
authors.forename: L
authors.initials: L
authors.lastname: Brochard
authors.forename: D
authors.initials: D
authors.lastname: Dreyfuss
mesh_terms: D002170:Canada; D003422:Critical Care / Q000379:methods* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003659:Decision Making, Organizational; D005602:France; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000706:statistics & numerical data; D008485:Medical Audit; D018579:Patient Selection; D008486:Physician Executives; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D013396:Suction / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires