Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
Department of Neonatology, Ankura Hospital for Women and Children, Hyderabad, Telangana, India.
Pediatr Pulmonol. 2021 Jun;56(6):1357-1365. doi: 10.1002/ppul.25345. Epub 2021 Mar 13.
To assess the effect of different frequencies of ventilator circuit changes in neonates and children through a systematic review and meta-analysis.
(1) "No routine change of ventilator circuit (unless visibly soiled)" versus "routine change at any fixed interval"; (2) routine change of circuit at "less frequent" versus "more frequent" intervals.
Primary outcomes were VAP rate (number of VAP episodes per 1000 ventilator-days) and all-cause mortality before discharge.
MEDLINE, CENTRAL, EMBASE, and CINAHL were systematically searched from inception till November 3, 2020. Two authors assessed trial eligibility and risk of bias, and independently extracted data. Data were synthesized using fixed effects model. GRADE was used to assess certainty of evidence (CoE).
We identified six studies enrolling 768 participants evaluating circuit changes at two fixed intervals. Meta-analysis of studies on circuit changes "once in less than 7 days" versus "once weekly" showed no difference in VAP rate (risk ratio: 0.83 [0.38-1.81]; one randomized controlled trial (RCT) and 0.94 [0.49-1.81]; two before-after studies) or mortality before discharge (0.67 [0.34-1.3]; one RCT and 1.01 [0.63-1.64]; two before-after studies). CoE was very low. Less frequent circuit changes reduced health-care costs. No study evaluating "circuit changes only when visibly soiled" versus "circuit changes at a fixed interval" was identified.
There is no evidence to suggest that ventilator circuits can be safely left unchanged until visibly soiled in neonates and children. Extending circuit changes interval to "once weekly" may not increase VAP rate (CoE-very low) and reduces healthcare costs.
通过系统评价和荟萃分析评估新生儿和儿童中不同频率更换呼吸机回路对呼吸机相关性肺炎（VAP）发生率和死亡率的影响。
（1）“不常规更换呼吸机回路（除非明显污染）”与“定期在任意固定间隔更换”；（2）在“更不频繁”与“更频繁”的间隔更换呼吸机回路。
主要结局为呼吸机相关性肺炎发生率（每 1000 个机械通气日发生的呼吸机相关性肺炎例次数）和出院前全因死亡率。
系统检索 MEDLINE、CENTRAL、EMBASE 和 CINAHL 数据库，检索时限从建库至 2020 年 11 月 3 日。两位作者评估试验的纳入标准和偏倚风险，并独立提取数据。采用固定效应模型进行数据合并。使用 GRADE 评估证据确定性（CoE）。
共纳入 6 项研究，涉及 768 例患者，评估了两种固定间隔更换呼吸机回路的方案。对“每 7 天更换 1 次以下”与“每周更换 1 次”的研究进行荟萃分析显示，VAP 发生率（风险比：0.83[0.38-1.81]；1 项随机对照试验和 0.94[0.49-1.81]；2 项前后对照研究）或出院前死亡率（0.67[0.34-1.3]；1 项随机对照试验和 1.01[0.63-1.64]；2 项前后对照研究）均无差异。CoE 为极低。更不频繁地更换呼吸机回路可降低医疗保健成本。未发现评估“仅在明显污染时更换呼吸机回路”与“在固定间隔更换呼吸机回路”的研究。
尚无证据表明新生儿和儿童的呼吸机回路可安全地保持不变直至明显污染。将更换呼吸机回路的间隔延长至“每周更换 1 次”可能不会增加 VAP 发生率（CoE-极低），同时可降低医疗保健成本。
