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Effect of Ventilator Circuit Changes on Ventilator-Associated Pneumonia: A Systematic Review and Meta-analysis
BACKGROUND: Recent guidelines concerning prevention of ventilator-associated pneumonia recommend
that ventilator circuits should not be changed routinely, but in practice circuit changes at
regular intervals persist. METHODS: We searched the MEDLINE, EMBASE, and SCOPUS databases
and reviewed citations to identify articles that reported the results of randomized controlled
trials and sequential comparison studies that provided a clearly defined intervention of circuit
changes (interval > 2 d) and the outcome measure of the development of ventilator-associated
pneumonia in mechanically ventilated adult patients. Both authors independently assessed the
validity of the included studies, and extracted data using a pre-designed data-collection form. We
used a random-effect model to combine data from studies that compared circuit changes every
2 days versus every 7 days, and circuit changes at regular intervals versus no routine circuit change.
RESULTS: The search yielded 10 reports, which included 19,169 patients. Compared to patients
exposed to circuit changes every 7 days, patients who received circuit changes every 2 days had a
higher risk of ventilator-associated pneumonia (odds ratio 1.928, 95% confidence interval 1.080–
3.443). Compared to no routine circuit change, changing the ventilator circuit at a 2-day or 7-day
interval was associated with an odds ratio of 1.126 (95% confidence interval 0.793–1.599). There
was a trend of reduced risk of pneumonia as circuit-change intervals were extended. CONCLUSIONS:
Frequent ventilator circuit changes are associated with a high risk of ventilator-associated
pneumonia. No routine circuit change is safe and justified. Hospital infection-control policies and
bedside practitioners should translate the evidence into clinical practice, if they haven’t done so
already. Key words: meta-analysis; respiratory care; pneumonia; prevention; ventilator circuit. [Respir
Care 2010;55(4):467– 474. © 2010 Daedalus Enterprises]
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发表于 2013-4-23 10:52
发表于 2013-4-23 11:09
发表于 2013-4-23 11:44
