title: Effect of heat and moisture exchangers on the prevention of ventilator-associated pneumonia in critically ill patients.
abstract: Ventilator-associated pneumonia (VAP) remains one of the major causes of infection in the intensive care unit (ICU) and is associated with the length of hospital stay, duration of mechanical ventilation, and use of broad-spectrum antibiotics. We compared the frequency of VAP 10 months prior to (pre-intervention group) and 13 months after (post-intervention group) initiation of the use of a heat and moisture exchanger (HME) filter. This is a study with prospective before-and-after design performed in the ICU in a tertiary university hospital. Three hundred and fourteen patients were admitted to the ICU under mechanical ventilation, 168 of whom were included in group HH (heated humidifier) and 146 in group HME. The frequency of VAP per 1000 ventilator-days was similar for both the HH and HME groups (18.7 vs 17.4, respectively; P = 0.97). Duration of mechanical ventilation (11 vs 12 days, respectively; P = 0.48) and length of ICU stay (11 vs 12 days, respectively; P = 0.39) did not differ between the HH and HME groups. The chance of developing VAP was higher in patients with a longer ICU stay and longer duration of mechanical ventilation. This finding was similar when adjusted for the use of HME. The use of HME in intensive care did not reduce the incidence of VAP, the duration of mechanical ventilation, or the length of stay in the ICU in the study population.
authors.affiliation: Divisão de Terapia Intensiva, Departamento de Cirurgia e Anatomia, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil. mamartins@hcrp.usp.br
authors.forename: M
authors.initials: M
authors.lastname: Auxiliadora-Martins
authors.forename: M G
authors.initials: MG
authors.lastname: Menegueti
authors.forename: E A
authors.initials: EA
authors.lastname: Nicolini
authors.forename: G C
authors.initials: GC
authors.lastname: Alkmim-Teixeira
authors.forename: F
authors.initials: F
authors.lastname: Bellissimo-Rodrigues
authors.forename: O A
authors.initials: OA
authors.lastname: Martins-Filho
authors.forename: A
authors.initials: A
authors.lastname: Basile-Filho
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D005260:Female; D006358:Hot Temperature; D006801:Humans; D006813:Humidity; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects / Q000295:instrumentation*; D012307:Risk Factors; D055815:Young Adult