Mechanical ventilation with or without 7-day circuit changes. A randomized controlled trial

M H Kollef, S D Shapiro, V J Fraser, P Silver, D M Murphy, E Trovillion, M L Hearns, R D Richards, L Cracchilo, L Hossin
Annals of Internal Medicine 1995 August 1, 123 (3): 168-74

OBJECTIVE: To determine whether a practice of not routinely changing ventilator circuits in patients who require prolonged mechanical ventilation is associated with an increased incidence of nosocomial pneumonia.

DESIGN: Randomized controlled trial.

SETTING: Intensive care units in two university-affiliated teaching hospitals.

PATIENTS: 300 patients admitted to an intensive care unit who required mechanical ventilation for more than 5 days.

INTERVENTION: Patients were randomly assigned to receive either no routine ventilator circuit changes or circuit changes every 7 days.

MEASUREMENTS: The primary outcome measure was the incidence of ventilator-associated pneumonia. Other outcome measures included duration of mechanical ventilation, length of hospital stay, and hospital mortality.

RESULTS: 147 patients were randomly assigned to receive no routine ventilator circuit changes, and 153 patients were randomly assigned to receive circuit changes every 7 days. The two groups were similar at the time of randomization with regard to demographic characteristics, intensive care unit admission diagnoses, and severity of illness. Ventilator-associated pneumonia was seen in 36 patients (24.5%) receiving no routine changes and in 44 patients (28.8%) receiving changes every 7 days (relative risk, 0.85 [95% CI, 0.55 to 1.17]). No statistically significant differences for hospital mortality, intensive care unit mortality, death during mechanical ventilation, death in patients with ventilator-associated pneumonia, or mortality directly attributed to ventilator-associated pneumonia were found between the two treatment groups (P > or = 0.11). Patients receiving changes every 7 days had 247 circuit changes costing a total of $7410; patients receiving no routine changes had a total of 11 circuit changes costing $330.

CONCLUSION: The elimination of routine ventilator circuit changes can reduce medical care costs without increasing the incidence of nosocomial pneumonia in patients who require prolonged mechanical ventilation.

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