Stamm A M
Department of Medicine, University of Alabama at Birmingham 35294, USA.
Am J Infect Control. 1998 Feb;26(1):71-3. doi: 10.1016/s0196-6553(98)70064-1.
The purpose of this research was to determine whether changing tubing circuits for mechanical ventilation less often than every 48 hours would allow maintenance of acceptably low rates for ventilator-associated pneumonia.
A computer search of the MEDLINE database from 1986 through 1996 was performed, and abstracts for 1992 through 1996 from the annual meetings of the Association for Professionals in Infection Control and Epidemiology and the Society for Healthcare Epidemiology of America were examined.
Eight studies indicate that the interval between ventilator tubing circuit changes can be extended to 7 days without increasing the rate of ventilator-associated pneumonia. Furthermore, the rate can be maintained at or below 10 pneumonias per 1000 ventilator-days, the approximate median of the National Nosocomial Infections Surveillance System. There is very little evidence to suggest that these circuits can safely be changed at longer intervals.
The weight of the evidence indicates that breathing circuits should be changed every 7 days. This practice of routine changes should be abandoned only if additional studies demonstrate that prolonged use of the same breathing circuit is associated with low rates of ventilator-associated pneumonia.
本研究的目的是确定机械通气管道更换间隔时间超过每48小时是否能维持呼吸机相关性肺炎的低发生率。
对1986年至1996年的MEDLINE数据库进行计算机检索，并查阅了1992年至1996年感染控制与流行病学专业人员协会及美国医疗保健流行病学学会年会的摘要。
八项研究表明，呼吸机管道更换间隔时间可延长至7天，而不会增加呼吸机相关性肺炎的发生率。此外，该发生率可维持在每1000呼吸机日10例肺炎或更低，这接近国家医院感染监测系统的中位数。几乎没有证据表明这些管道能安全地延长更换间隔时间。
证据表明呼吸回路应每7天更换一次。只有当更多研究表明延长使用同一呼吸回路与低呼吸机相关性肺炎发生率相关时，才应放弃这种常规更换做法。
