title: One-week versus 2-day ventilator circuit change in neonates with prolonged ventilation: cost-effectiveness and impact on ventilator-associated pneumonia.
abstract: OBJECTIVE
  To investigate the impact of 1-week ventilator circuit change on ventilator-associated pneumonia and its cost-effectiveness compared with a 2-day change.
  
  
  METHODS
  An observational cohort study.
  
  
  METHODS
  A tertiary level neonatal intensive care unit in a university-affiliated teaching hospital in Taiwan. Patients All neonates in the neonatal intensive care unit receiving invasive intubation for more than 1 week from July 1, 2011, through December 31, 2013.
  
  
  METHODS
  We investigated the impact of 2 ventilator circuit change regimens, either every 2 days or 7 days, on ventilator-associated pneumonia of our cohort.
  
  
  RESULTS
  A total of 361 patients were maintained on mechanical ventilators for 13,981 days. The 2 groups did not differ significantly in any demographic characteristics. The rate of ventilator-associated pneumonia was comparable between the 2-day group and the 7-day group (8.2 vs 9.5 per 1,000 ventilator-days, P=.439). The durations of mechanical ventilation and hospital stay, and rates of bloodstream infection and mortality, were also comparable between the 2 groups. Switching from a 2-day to a 7-day change policy would save our neonatal intensive care unit a yearly sum of US $29,350 and 525 working hours.
  
  
  CONCLUSIONS
  Decreasing the frequency of ventilator circuit changes from every 2 days to once per week is safe and cost-effective in neonates requiring prolonged intubation for more than 1 week.
authors.affiliation: 1Division of Pediatric Neonatology,Department of Pediatrics,Chang Gung Memorial Hospital,Taoyuan,Taiwan.
authors.forename: Shih-Ming
authors.initials: SM
authors.lastname: Chu
authors.affiliation: 2Department of Respiratory Therapy,Chang Gung Memorial Hospital,Yunlin,Taiwan.
authors.forename: Mei-Chin
authors.initials: MC
authors.lastname: Yang
authors.affiliation: 2Department of Respiratory Therapy,Chang Gung Memorial Hospital,Yunlin,Taiwan.
authors.forename: Hsiu-Feng
authors.initials: HF
authors.lastname: Hsiao
authors.affiliation: 1Division of Pediatric Neonatology,Department of Pediatrics,Chang Gung Memorial Hospital,Taoyuan,Taiwan.
authors.forename: Jen-Fu
authors.initials: JF
authors.lastname: Hsu
authors.affiliation: 1Division of Pediatric Neonatology,Department of Pediatrics,Chang Gung Memorial Hospital,Taoyuan,Taiwan.
authors.forename: Reyin
authors.initials: R
authors.lastname: Lien
authors.affiliation: 1Division of Pediatric Neonatology,Department of Pediatrics,Chang Gung Memorial Hospital,Taoyuan,Taiwan.
authors.forename: Ming-Chou
authors.initials: MC
authors.lastname: Chiang
authors.affiliation: 1Division of Pediatric Neonatology,Department of Pediatrics,Chang Gung Memorial Hospital,Taoyuan,Taiwan.
authors.forename: Ren-Huei
authors.initials: RH
authors.lastname: Fu
authors.affiliation: 1Division of Pediatric Neonatology,Department of Pediatrics,Chang Gung Memorial Hospital,Taoyuan,Taiwan.
authors.forename: Hsuan-Rong
authors.initials: HR
authors.lastname: Huang
authors.affiliation: 4Laboratory for Epidemiology,Department of Health Care Management,Healthy Aging Research Center,Chang Gung University,Taoyuan,Taiwan.
authors.forename: Kuang-Hung
authors.initials: KH
authors.lastname: Hsu
authors.affiliation: 5College of Medicine,Chang Gung University,Taoyuan,Taiwan.
authors.forename: Ming-Horng
authors.initials: MH
authors.lastname: Tsai
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000191:economics / Q000379:methods*; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D053717:Pneumonia, Ventilator-Associated / Q000191:economics / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000191:economics / Q000379:methods*; D012189:Retrospective Studies; D013624:Taiwan; D013997:Time Factors