From the 2018 HVPAA National Conference
Sandeep Sharma (Baptist Regional Medical Center), Kshitij Thakur (Crozer-Chester Medical Center), Darrell Mr. (Continue Care hospitlal)
Ventilator circuit change more than every 48 hours is discouraged by current guidelines. The evidence supporting these recommendations come from a few observational and randomized controlled trials with varying results.
Our goal was to asses outcomes and cost analysis between daily and weekly ventilator circuit change, over an year, at a Long term acute care facility.
We implemented change form daily to weekly (or as visibly soiled) ventilator circuit changes and all extended devices including nebulizer adaptors, heat and moisture exchanger, expiratory filter, and inline suction catheters. We compared Ventilator associated event (VAE) rates between pre intervention and post intervention group. Chi square test was used to assess differences between two group.
The pre and post intervention groups had 100 and 111 patients respectively. No significant differences were seen in patient characteristics including age, sex, race and reason for mechanical ventilation between two groups. The VAE rate /1000 patient days was reduced from 5.81 to 2.07 (p=0.03). Cost/ventilator day reduced by$10.19
In our study, adoption of current ventilator circuit change practice guidelines was associated with Clinical and statistical significant reduction in VAE, and no change in VAP events and mortality. Additionally there was an associated reduction in cost of care. Larger RCT are needed in modern ICU environments to further evaluate these findings.
Implications for the Patient
Most common causes of VAEs are pneumonia, atelectasis, pulmonary edema and ARDS. With decrease in VAEs we decrease the incidence of above mentioned conditions which helps in getting the patient out of ICU, lowers healthcare cost and reduce readmission rate.