Effect of frequency of ventilator circuit changes (3 vs 7 days) on the rate of ventilator-associated pneumonia in PICU.
OBJECTIVE
Ventilator-associated pneumonia (VAP) is associated with significant morbidity and mortality in pediatric intensive care unit (PICU). Our purpose was to evaluate the effects of ventilator circuit change on the rate of VAP in the PICU.


METHODS
A prospective randomized controlled trial was conducted at a university hospital PICU. Children (younger than 18 years) who received mechanical ventilation from December 2006 to November 2007 were randomly assigned to receive ventilator circuit changes every 3 or 7 days.


RESULTS
Of 176 patients, 88 were assigned to receive ventilator circuit every 3 days and 88 patients had a change weekly. The rate of VAP was 13.9/1000 ventilator days for the 3-day circuit change (n = 12) vs 11.5/1000 ventilator days (n = 10) for the 7-day circuit change (odds ratio, 0.8; confidence interval, 0.3-1.9; P = .6). There was a trend toward decreased PICU stay and mortality rate in 7-day change group compared to 3-day change group but did not reach statistical significance. Furthermore, switching from a 3-day to a 7-day change policy could save costs up to US $22,000/y.


CONCLUSIONS
The 7-day ventilator circuit change did not contribute to increased rates of VAP in our PICU. Thus, it may be used as a guide to save workload and supply costs.
Samransamruajkit
Rujipat
R
Division of Pediatric Pulmonary and Critical Care, Department of Pediatrics, Chulalongkorn University, Bangkok 10330, Thailand. rujijantara@pol.net
Jirapaiboonsuk
Suree
S
Siritantiwat
Sirirush
S
Tungsrijitdee
Ornanong
O
Deerojanawong
Jitladda
J
Sritippayawan
Suchada
S
Prapphal
Nuanchan
N
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000191:economics; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D012307:Risk Factors; D013785:Thailand; D013997:Time Factors; D016896:Treatment Outcome; D012122:Ventilators, Mechanical