Shih-Ming Chu1, Mei-Chin Yang2, Hsiu-Feng Hsiao2, Jen-Fu Hsu1, Reyin Lien1, Ming-Chou Chiang1, Ren-Huei Fu1, Hsuan-Rong Huang1, Kuang-Hung Hsu3, Ming-Horng Tsai4. 1. 1Division of Pediatric Neonatology,Department of Pediatrics,Chang Gung Memorial Hospital,Taoyuan,Taiwan. 2. 2Department of Respiratory Therapy,Chang Gung Memorial Hospital,Yunlin,Taiwan. 3. 4Laboratory for Epidemiology,Department of Health Care Management,Healthy Aging Research Center,Chang Gung University,Taoyuan,Taiwan. 4. 5College of Medicine,Chang Gung University,Taoyuan,Taiwan.
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. DESIGN: An observational cohort study. SETTING: 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. INTERVENTION: We investigated the impact of 2 ventilator circuit change regimens, either every 2 days or 7 days, on ventilator-associated pneumonia of our cohort. MEASUREMENTS AND MAIN 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. CONCLUSION: 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.
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. DESIGN: An observational cohort study. SETTING: 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. INTERVENTION: We investigated the impact of 2 ventilator circuit change regimens, either every 2 days or 7 days, on ventilator-associated pneumonia of our cohort. MEASUREMENTS AND MAIN 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. CONCLUSION: 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.