Ventilator-Associated Pneumonia Effect of frequency of ventilator circuit changes (3 vs 7 days) on the rate of ventilator-associated pneumonia in PICU Rujipat Samransamruajkit MD a, ⁎ , Suree Jirapaiboonsuk MD c , Sirirush Siritantiwat b , Ornanong Tungsrijitdee b , Jitladda Deerojanawong a,c , Suchada Sritippayawan a,c , Nuanchan Prapphal a,c a Division of Pediatric Pulmonary and Critical Care, Department of Pediatrics, Chulalongkorn University, Bangkok 10330, Thailand b Registered Critical Care Nurse, Chulalongkorn University, Bangkok 10330, Thailand c Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand Keywords: VAP in PICU; Ventilator circuit change Abstract Purpose: Ventilator-associated pneumonia (VAP) is associated with significant morbidity and mortality in pediatric intensive care unit (PICU). Our purpose was to evaluate the effects of ventilator circuit change on the rate of VAP in the PICU. Methods: A prospective randomized controlled trial was conducted at a university hospital PICU. Children (younger than 18 years) who received mechanical ventilation from December 2006 to November 2007 were randomly assigned to receive ventilator circuit changes every 3 or 7 days. Results: Of 176 patients, 88 were assigned to receive ventilator circuit every 3 days and 88 patients had a change weekly. The rate of VAP was 13.9/1000 ventilator days for the 3-day circuit change (n = 12) vs 11.5/1000 ventilator days (n = 10) for the 7-day circuit change (odds ratio, 0.8; confidence interval, 0.3- 1.9; P = .6). There was a trend toward decreased PICU stay and mortality rate in 7-day change group compared to 3-day change group but did not reach statistical significance. Furthermore, switching from a 3-day to a 7-day change policy could save costs up to US $22,000/y. Conclusions: The 7-day ventilator circuit change did not contribute to increased rates of VAP in our PICU. Thus, it may be used as a guide to save workload and supply costs. Crown Copyright © 2010 Published by Elsevier Inc. All rights reserved. 1. Background Ventilator-associated pneumonia (VAP) is defined as nosocomial pneumonia in mechanically ventilated patients that was not present at the time of intubation. It is the most frequent infectious complication among patients admitted to the intensive care unit. It is associated with increased morbidity, mortality, and health care costs [1-3]. The causes of VAP vary and differ across patient populations and types of ICU. The estimated incidence of VAP in PICU ranges from 2.5 to 11.6 per 1000 ventilator days [4-6]. Various strategies to reduce the risk of VAP have included head ⁎ Corresponding author. Tel.: +66 2 256-4996x129, 123; fax: +66 2 256-4911. E-mail address: rujijantara@pol.net (R. Samransamruajkit). 0883-9441/$ – see front matter. Crown Copyright © 2010 Published by Elsevier Inc. All rights reserved. doi:10.1016/j.jcrc.2009.03.005 Journal of Critical Care (2010) 25, 56–61