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A Meta-Analysis of the Ventilator Circuit Change Period on Ventilator-Associated Pneumonia

인공호흡기 회로 교환주기가 인공호흡기 관련 폐렴에 미치는 영향에 관한 메타 분석

  • Song, Ju Hyun (Department of Nursing, Chung-Ang University Medical Center) ;
  • Kim, Kyung Hee (Department of Nursing, College of Medicine, Chung-Ang University)
  • Received : 2010.09.01
  • Accepted : 2010.10.26
  • Published : 2010.12.31

Abstract

Purpose: This meta-analysis was aimed to investigate the evidence of proper period of the ventilator circuit change using existing research. Methods: For this study, 14 published studies between 1995 and 2010 were tested by Macaskill, Funnel Plot, the Odds Ratio of DerSimonian and Laird, Fisher and Liptak analysis. Results: There were no publication bias found in the subjects. The results of the meta-analysis demonstrated no statistically significant differences were observed in neither the Odds Ratio (OR=1.18, 95% CI=0.94-1.47) of the frequency of ventilator-associated pneumonia and the mortality based on the period of the ventilator circuit change (Fisher p=.332, Liptak p=.498), nor the ventilation duration of ventilator (Fisher p=.843, Liptak p=.506), and the hospital length of stay (Fisher p=.254, Liptak p=.480). Conclusion: In order to present more concrete guidelines on the period of the ventilator circuit change, further research is warranted to thoroughly control confounding variables which related to the periods of the ventilator circuit change.

Keywords

References

  1. 대한병원감염관리학회(2006). 병원감염관리 (제3판). 서울: 한미의학.
  2. 이상오, 김의석, 김효열, 박은숙, 진혜영, 기현균 등(2008). 전국병원감염감시체계 중환자실 부문 결과 보고: 2007년 7 월에서 2008년 6월까지의 자료 정리. 병원감염관리, 13(2), 69-82.
  3. 이진희(2008). 인공호흡기 관련 폐렴 발생률과 위험요인: 일개 병원 중환자실을 대상으로. 고려대학교 석사학위논문, 서울.
  4. 장선영(2001). 중환자실의 호흡기관련 폐렴(Ventilatorassociated pneumonia, VAP) 발생과 재원일수 및 진료비 분석. 연세대학교 석사학위논문, 서울.
  5. Alexiou, V. G., Ierodiakonou, V., Dimopoulos, G., & Falagas, M. E. (2009). Impact of patient position on the incidence of ventilator-associated pneumonia: A meta-analysis of randomized controlled trials. Journal of Critical Care, 24(4), 515-522. https://doi.org/10.1016/j.jcrc.2008.09.003
  6. Centers for Disease Control and Prevention (2009). Public health grand rounds: Office of the director. Retrieved January 20, 2010, from www.cdc.gov/ about/grand-rounds/archives/2009/download/GR-10150 9.pdf
  7. Chastre, J., & Fagon, J. Y. (2002). Ventilator-associated pneumonia. American Journal of Respiratory and Critical Care Medicine, 165(7), 867-903. https://doi.org/10.1164/ajrccm.165.7.2105078
  8. Dezfulian, C., Shojania, K., Collard, H. R., Kim, H. M., Matthay, M. A., & Saint, S. (2005). Subglottic secretion drainage for preventing ventilatorassociated pneumonia: A meta-analysis. The American Journal of Medicine, 118(1), 11-18. https://doi.org/10.1016/j.amjmed.2004.07.051
  9. Dixon, C., McLean, A. P. H., Lallo, R. D., & Loo, V. G. (1998). Ventilator-associated pneumonia and ventilator circuit changes: A comparison of 2-day versus 7-day circuit changes. The Canadian Journal of Infection Control, 13(2), 51-54.
  10. Fink, J. B., Krause, S. A., Barrett, L., Schaaff, D., & Alex, C. G. (1998). Extending ventilator circuit change interval beyond 2 days reduces the likelihood of ventilator-associated pneumonia. Chest, 113(2), 405-411. https://doi.org/10.1378/chest.113.2.405
  11. Garcia, R., Jendresky, L., Colbert, L., Bailey, A., Zaman, M., & Majumder, M. (2009). Reducing ventilator-associated pneumonia through advanced oral-dental care: A 48-month study. American Journal of Critical Care, 18(6), 523-532. https://doi.org/10.4037/ajcc2009311
  12. Haley, R. W., Culver, D. H., White, J. W., Morgan, W. M., Emori, T. G., Munn, V. P., et al. (1985). The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. American Journal of Epidemiology, 121(2), 182-205. https://doi.org/10.1093/oxfordjournals.aje.a113990
  13. Han, J. N., Liu, Y. P., Ma, S., Zhu, Y. J., Sui, S. H., Chen, X. J., et al. (2001). Effects of decreasing the frequency of ventilator circuit changes to every 7 days on the rate of ventilator-associated pneumonia in a Beijing Hospital. Respiratory Care, 46(9), 891-896.
  14. Hess, D., Burns, E., Romagnoli, D., & Kacmarek, R. M. (1995). Weekly ventilator circuit changes: A strategy to reduce costs without affecting pneumonia rates. Anesthesiology, 82(4), 903-911. https://doi.org/10.1097/00000542-199504000-00013
  15. Kim, N. C., & Kim, Y. R. (2003). The incidence rate of ventilator-associated pneumonia in relation to the exchange of circuit cycle. Korean Academy of Adult Nursing, 15(3), 463-471.
  16. Kollef, M. H. (1993). Ventilator associated pneumonia. A multivariate analysis. The Journal of the American Medical Association, 270(16), 1965-1970. https://doi.org/10.1001/jama.270.16.1965
  17. Kollef, M. H., Shapiro, S. D,, Fraser, V. J., Silver, P., Murphy, D. M., Trovillion, E., et al. (1995). Mechanical Ventilation with or without 7-day circuit changes. A randomized controlled trial. Annals of Internal Medicine, 123(3), 168-174. https://doi.org/10.7326/0003-4819-123-3-199508010-00002
  18. Kotilainen, H. R., & Keroack, M. A. (1997). Cost analysis and clinical impact of weekly ventilator circuit changes in patients in intensive care unit. American Journal of Infection Control, 25(2), 117-120. https://doi.org/10.1016/S0196-6553(97)90038-9
  19. Lien, T. C., Lin, M. Y., Chu, C. C., Kuo, B. I. T., Wang, F. D., & Wang, J. H. (2001). Ventilatorassociated pneumonia with circuit changes every 2 days versus every week. Chinese Medical Journal (Taipei), 64(3), 161-167.
  20. Long, M. N., Wickstrom, G., Grimes, A., Benton, C. F., Belcher, B., & Stamm, A. M. (1996). Prospective, randomized study of ventilator-associated pneumonia in patients with one versus three ventilator circuit changes per week. Infection Control and Hospital Epidemiology, 17(1), 14-19. https://doi.org/10.1086/647183
  21. Lorente, L., Lecuona, M., Galván, R., Ramos, M. J., Mora, M. L., & Sierra, A. (2004). Periodically changing ventilator circuits is not necessary to prevent ventilator-associated pneumonia when a heat and moisture exchanger is used. Infection Control and Hospital Epidemiology, 25(12), 1077-1082. https://doi.org/10.1086/502347
  22. Makhoul, I. R., Kassis, I., Berant, M., Hashman, N., Revach, M., & Sujov, P. (2001). Frequency of change of ventilator circuit in premature infants: Impact on ventilator-associated pneumonia. Pediatric Critical Care Medicine, 2(2), 127-132. https://doi.org/10.1097/00130478-200104000-00006
  23. Oh, H. S., Choi, Y. K., Lee, B. N., Shim, M. Y., Choi, H. S., Kim, E. C., et al. (2000). A prospective study on the incidence of ventilator-associated pneumonia in patients with circuit changes every 3days versus weekly changes. Korean Journal of Nosocomial Infection Control, 5(1), 9-21.
  24. Powers, J. M. (2007). Factors related to the development of ventilator-associated pneumonia in the neuroscience patient population. Unpublished doctoral dissertation, Indiana University, Bloomington, USA.
  25. Rello, J., Catalán, M., Díaz, E., Bodí, M., & Álvarez, B. (2002). Associations between empirical antimicrobial therapy at the hospital and mortality in patients with severe community-acquired pneumonia. Intensive Care Medicine, 28(8), 1030- 1035 https://doi.org/10.1007/s00134-002-1325-3
  26. Samransamruajkit, R., Jirapaiboonsuk, S., Siritantiwat, S., Tungsrijitdee, O., Deerojanawong, J., Sritippayawan, S., et al. (2009). Effect of frequency of ventilator circuit changes (3 vs 7days) on the rate of ventilator-associated pneumonia in PICU. Journal of Critical Care, 25(1), 56-61.
  27. Siempos, I. I., Vardakas, K. Z., & Falagas, M. E. (2008). Closed tracheal suction systems for prevention of ventilator-associated pneumonia. British Journal of Anaesthesia, 100(3), 299-306. https://doi.org/10.1093/bja/aem403
  28. Tablan, D. C., Anderson, L. J., Besser, R., Bridges, C., & Hajjeh, R. (2004). Guidelines for preventing health-care-associated pneumonia, 2003: Recommendations of CDC and the healthcare infection control practices advisory committee. MMWR, 53(RR03), 1-36. Retrieved January 20, 2010, from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5303a1.htm
  29. Tantipong, H., Morkchareonpong, C., Jaiyindee, S., & Thamlikitkul, V. (2008). Randomized controlled trial and meta-analysis of oral decontamination with 2% chlorhexidine solution for the prevention of ventilator-associated pneumonia. Infection Control and Hospital Epidemiology, 29(2), 131-136. https://doi.org/10.1086/526438
  30. Thompson, R. E. (1996). Incidence of ventilatorassociated pneumonia (VAP) with 14-day circuit change in a subacute environment. Respiratory Care, 41(7), 601-606.