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,
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
of Pulmonary Medicine, Department of Internal Medicine; School of
Medicine, Chung Shan Medical University Hospital; Chung Shan Medical
Endotracheal tube (ET)
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.
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.
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.
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.