Kollef M H, Shapiro S D, Fraser V J, Silver P, Murphy D M, Trovillion E, Hearns M L, Richards R D, Cracchilo L, Hossin L
Pulmonary and Critical Care Division, Washington University School of Medicine, St. Louis, MO 63110, USA.
Ann Intern Med. 1995 Aug 1;123(3):168-74. doi: 10.7326/0003-4819-123-3-199508010-00002.
To determine whether a practice of not routinely changing ventilator circuits in patients who require prolonged mechanical ventilation is associated with an increased incidence of nosocomial pneumonia.
Randomized controlled trial.
Intensive care units in two university-affiliated teaching hospitals.
300 patients admitted to an intensive care unit who required mechanical ventilation for more than 5 days.
Patients were randomly assigned to receive either no routine ventilator circuit changes or circuit changes every 7 days.
The primary outcome measure was the incidence of ventilator-associated pneumonia. Other outcome measures included duration of mechanical ventilation, length of hospital stay, and hospital mortality.
147 patients were randomly assigned to receive no routine ventilator circuit changes, and 153 patients were randomly assigned to receive circuit changes every 7 days. The two groups were similar at the time of randomization with regard to demographic characteristics, intensive care unit admission diagnoses, and severity of illness. Ventilator-associated pneumonia was seen in 36 patients (24.5%) receiving no routine changes and in 44 patients (28.8%) receiving changes every 7 days (relative risk, 0.85 [95% CI, 0.55 to 1.17]). No statistically significant differences for hospital mortality, intensive care unit mortality, death during mechanical ventilation, death in patients with ventilator-associated pneumonia, or mortality directly attributed to ventilator-associated pneumonia were found between the two treatment groups (P > or = 0.11). Patients receiving changes every 7 days had 247 circuit changes costing a total of $7410; patients receiving no routine changes had a total of 11 circuit changes costing $330.
The elimination of routine ventilator circuit changes can reduce medical care costs without increasing the incidence of nosocomial pneumonia in patients who require prolonged mechanical ventilation.
确定在需要长期机械通气的患者中不常规更换呼吸机管路的做法是否与医院获得性肺炎发病率增加相关。
随机对照试验。
两家大学附属医院的重症监护病房。
300名入住重症监护病房且需要机械通气超过5天的患者。
患者被随机分配接受不常规更换呼吸机管路或每7天更换一次管路。
主要结局指标是呼吸机相关性肺炎的发病率。其他结局指标包括机械通气时间、住院时间和医院死亡率。
147名患者被随机分配接受不常规更换呼吸机管路，153名患者被随机分配接受每7天更换一次管路。两组在随机分组时在人口统计学特征、重症监护病房入院诊断和疾病严重程度方面相似。接受不常规更换的36名患者（24.5%）和接受每7天更换一次的44名患者（28.8%）发生了呼吸机相关性肺炎（相对危险度，0.85 [95%可信区间，0.55至1.17]）。两个治疗组在医院死亡率、重症监护病房死亡率、机械通气期间死亡、呼吸机相关性肺炎患者死亡或直接归因于呼吸机相关性肺炎的死亡率方面未发现统计学显著差异（P≥0.11）。每7天更换一次管路的患者进行了247次管路更换，总计花费7410美元；接受不常规更换的患者共进行了11次管路更换，花费330美元。
对于需要长期机械通气的患者，取消常规呼吸机管路更换可降低医疗费用，且不增加医院获得性肺炎的发病率。
