Perhimpunan Dokter Paru Indonesia - The association of ventilator-associated pneumonia with the frequent exchange of endotracheal tube
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The association of ventilator-associated pneumonia with the frequent exchange of endotracheal tube




Li YiaTing1, Lu MinChi2, Yang ShunFa3 and Wang YaoChen4
1Division of Respiratory Therapy, Department of Internal Medicine; Institute of Medicine, Chung Shan Medical University Hospital; Chung Shan Medical University, Taichung, Taiwan, 2Division of Infectious Disease, Department of Internal Medicine; Department of Microbiology and Immunology, College of Medicine, Chung Shan Medical University Hospital; Chung Shan Medical University, Taichung, Taiwan, 3Department of Medical Research;Institute of Medicine, Chung Shan Medical University Hospital; Chung Shan Medical University, Taichung, Taiwan, 4Division of Pulmonary Medicine, Department of Internal Medicine; School of Medicine, Chung Shan Medical University Hospital; Chung Shan Medical University, Taichung, Taiwan



Endotracheal tube (ET) changes in patients plus the risk of airway injury and introducing endogenous oropharyngeal bacteria into patient's lower airway. The interval of ET exchange in patients receiving prolonged mechanical ventilation (PMV) is currently based on clinician's discretion in Taiwan and remains a dilemma of respiratory care. In this study, we would like to know whether it is safe to prolong the use of the ET without causing an increase in the incidence of ventilator associated pneumonia in patients under long term mechanical ventilator support.

Methods: Eleven PMV patients were recruited from respiratory care wards (RCW) and divided into two groups by randomized complete block design. ET was changed either every 30 days (control group) or 90 days (experiment group). The incidence of VAP and cumulative rate of patients remaining free of VAP were assessed.

Results: A total of 48 times of ET changes were completed in 11 patients. The incidence of VAP were 8.8% (3/34 times) in the control group and 42.9% (6/14 times) in the experiment group (P=.01). The cumulative rate of patients remaining free of VAP probability was better in the group of routinely exchanged every 30 days during the study period (P=.002). There were no statistically significant differences between the two groups including microorganisms that caused VAP, disease severity classification at VAP onset, transferred to ICU and hospital mortality.

Conclusion: Routine 30 days exchange of ET could reduce the incidence of VAP when compare with prolonged ET exchange, but should be weighed on the possible risk of airway trauma during the invasive procedure.


http://erj.ersjournals.com/content/48/suppl_60/PA2640



PDPI Jatim. 21/03/17.



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