C García

Ventilator-associated pneumonia using a closed versus an open tracheal suction system.

Objective:The aim of this study was to analyze the prevalence of ventilator-associated pneumonia (VAP) using a closed-tracheal suction system vs. an open system. Design:Prospective and randomized study, from October 1, 2002, to December 31, 2003. Setting:A 24-bed medical-surgical intensive care unit in a 650-bed tertiary hospital. Patients:Patients requiring mechanical ventilation for >24 hrs. Interventions:Patients were randomized into two groups; one group was suctioned with the closed-tracheal suctioning system and another group with the open system. Measurements:Throat swabs were taken at admission and twice a week until discharge to classify pneumonia in endogenous and exogenous. Main Results:A total of 443 patients (210 with closed-tracheal suction system and 233 with the open system) were included. There were no significant differences between groups of patients in age, sex, diagnosis groups, mortality, number of aspirations per day, and Acute Physiology and Chronic Health Evaluation II score. No significant differences were found in either the percentage of patients who developed VAP (20.47% vs. 18.02%) or in the number of VAP cases per 1000 mechanical ventilation-days (17.59 vs. 15.84). There were also no differences in the VAP incidence by mechanical ventilation duration. At the same time, we did not find any differences in the incidence of exogenous VAP. Likewise, there were also no differences in the microorganisms responsible for pneumonia. Patient cost per day for the closed suction was more expensive than the open suction system (

Influence of tracheostomy on the incidence of central venous catheter-related bacteremia

11.11 ±

Equivalence of posterior internal jugular and subclavian accesses in the incidence of central venous catheter related bacteremia

2.25 vs.

Prolonged Intubation Rates After Coronary Artery Bypass Surgery and ICU Risk Stratification Score

2.50 ±

Internal jugular venous catheter-related bacteremia according to central and posterior accesses

1.12, p < .001). Conclusion:We conclude that in our study, the closed-tracheal suction system did not reduce VAP incidence, even for exogenous pneumonia.

Reconnection to mechanical ventilation for 1 h after a successful spontaneous breathing trial reduces reintubation in critically ill patients: a multicenter randomized controlled trial

Although there are many studies on catheter-related infection, there are scarce data about the influence of tracheostomy in the incidence of central venous catheter-related bacteremia (CRB). In this cohort study, we found a higher incidence of CRB in patients with tracheostomy than without (11.25 vs. 1.43 per 1,000 catheter-days; odds ratio [OR] = 7.99; 95% confidence interval [CI] = 4.38–infinite; P < 0.001). Besides, we found a higher incidence of CRB in patients with tracheostomy using the jugular access compared to subclavian access (21.64 vs. 5.11 per 1,000 catheter-days; OR = 4.23; 95% CI = 1.44–infinite; P = 0.0097).

Arterial catheter-related infection according to the catheter site

Age (years) 57.30 ± 17.29 57.99 ± 16.70 0.63 Male sex 499 (56.9%) 94 (55.6%) 0.80 APACHE II score 13.94 ± 4.97 13.99 ± 5.21 0.89 Diagnosis group Cardiology 202 (23.0%) 36 (21.3%) 0.69 Respiratory 144 (16.4%) 31 (18.3%) 0.57 Digestive 67 (7.6%) 11 (6.5%) 0.64 Neurological 221 (25.2%) 41 (24.3%) 0.85 Traumatology 220 (25.1%) 44 (26.0%) 0.77 Intoxication 23 (2.6%) 6 (3.6%) 0.61 Order of catheter insertion First 712 (81.2%) 133 (78.7%) 0.46 Second 131 (14.9%) 29 (17.2%) 0.48 Third 34 (3.9%) 7 (4.1%) 0.99 Use of mechanical ventilation 655 (78.9%) 129 (76.3%) 0.70 Use of antimicrobials 695 (79.2%) 131 (77.5%) 0.68 Use of total parenteral nutrition 111 (12.7%) 24 (14.20%) 0.61 Use of pulmonary artery catheter 91 (10.4%) 19 (11.24%) 0.78 Reason for catheter removal Death 118 (13.5%) 23 (13.6%) 0.99 Suspicion of catheter-related infection 82 (9.3%) 16 (9.5%) 0.99 Change with guidewire due to longer need 114 (13.0%) 21 (12.4%) 0.90 No longer needed 541 (61.7%) 105 (62.1%) 0.93 Accidental removal 22 (2.5%) 4 (2.4%) 0.99 Duration with the index catheter (days) 8.90 ± 3.74 9.75 ± 3.48 0.007 CVC-RB 8 (0.9%) 2 (1.2%) 0.99 CVC-RB density incidence (per 1,000 catheter-days) 1.02 1.21 0.99 a