María Lecuona

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 (

Tracheal suction by closed system without daily change versus open system

11.11 ±

The Use of Rifampicin-Miconazole—Impregnated Catheters Reduces the Incidence of Femoral and Jugular Catheter-Related Bacteremia

2.25 vs.

Ventilator-associated pneumonia with or without toothbrushing: a randomized controlled trial

2.50 ±

Periodically changing ventilator circuits is not necessary to prevent ventilator-associated pneumonia when a heat and moisture exchanger is used

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.

Bacterial filters in respiratory circuits: an unnecessary cost?

BackgroundTracheal suctioning costs are higher with a closed tracheal suction system (CTSS) than with an open system (OTSS), due to the need for complete daily change as recommended by the manufacturer. However, is it necessary to change the closed system daily?ObjectiveTo evaluate the tracheal suctioning costs and incidence of ventilator-associated pneumonia (VAP) using closed system without daily change vs OTSS.DesignProspective and randomised study.SettingAn Intensive Care Unit in a university hospital.PatientsPatients requiring mechanical ventilation.InterventionsPatients were randomly assigned to CTSS without daily change or OTSS. We used a CTSS that allowed partial or complete change.Measurements and resultsThere were no significant differences between both groups of patients (236 with CTSS and 221 with OTSS) in gender, age, diagnosis, APACHE-II score, mortality, number of aspirations per day, percentage of patients who developed VAP (13.9 vs 14.1%) or the number of ventilator-associated pneumonia per 1000 days of mechanical ventilation (14.1 vs 14.6). There were not significant differences in tracheal suctioning costs per patient/day between CTSS vs OTSS (2.3 ± 3.7 vs 2.4 ± 0.5 Euros; p = 0.96); however, when length of mechanical ventilation was lower than 4 days, the cost was higher with CTSS than with OTSS (7.2 ± 4.7 vs 1.9 ± 0.6 Euros; p < 0.001); and when length of mechanical ventilation was higher than 4 days, the cost was lower with CTSS than with OTSS (1.6 ± 2.8 vs 2.5 ± 0.5 Euros; p < 0.001).ConclusionCTSS without daily change is the optimal option for patients needing tracheal suction longer than 4 days.

Epidemiology of methicillin-resistant Staphylococcus aureus at a university hospital in the Canary Islands.

BACKGROUND The guidelines of the Centers for Disease Control and Prevention do not recommend the use of an antimicrobial- or antiseptic-impregnated catheter for short-term use. In previous studies, we have found a higher incidence of central venous catheter-related bacteremia among patients with femoral and central jugular accesses than among patients with other venous accesses. OBJECTIVE The objective of our study was to determine the incidence of central venous catheter-related bacteremia associated with rifampicin-miconazole-impregnated catheters and standard catheters in patients with femoral and central jugular venous accesses. METHODS This was a cohort study, conducted in the 24-bed polyvalent medical-surgical intensive care unit of a university hospital. We included patients who were admitted to the intensive care unit from 1 June 2006 through 30 September 2007 and who underwent femoral or central jugular venous catheterization. RESULTS We inserted 184 femoral (73 rifampicin-miconazole-impregnated catheters and 111 standard catheters) and 241 central jugular venous catheters (114 rifampicin-miconazole-impregnated catheters and 127 standard catheters). We found a lower rate of central venous catheter-related bacteremia associated with rifampicin-miconazole-impregnated catheters than with standard catheters among patients with femoral access (0 vs. 8.62 cases per 1000 catheter-days; odds ratio, 0.13; 95% confidence interval, 0.00-0.86; P = .03) and among patients with central internal jugular access (0 vs. 4.93 cases per 1000 catheter-days; odds ratio, 0.13; 95% confidence interval, 0.00-0.93; P = .04). CONCLUSIONS Rifampicin-minonazole-impregnated catheters are associated with a statistically significant reduction in the incidence of catheter-related bacteremia in patients with short-term catheter use at the central jugular and femoral sites.

Lower associated costs using rifampicin-miconazole‒impregnated catheters compared with standard catheters.

Certain guidelines for the prevention of ventilator-associated pneumonia (VAP) recommend oral care with chlorhexidine, but none refer to the use of a toothbrush for oral hygiene. The role of toothbrush use has received scant attention. Thus, the objective of this study was to compare the incidence of VAP in critical care patients receiving oral care with and without manual brushing of the teeth. This was a randomized clinical trial developed in a 24-bed medical-surgical intensive care unit (ICU). Patients undergoing invasive mechanical ventilation for than 24 h were included. Patients were randomly assigned to receive oral care with or without toothbrushing. All patients received oral care with 0.12 % chlorhexidine digluconate. Tracheal aspirate samples were obtained during endotracheal intubation, then twice a week, and, finally, on extubation. There were no significant differences between the two groups of patients in the baseline characteristics. We found no statistically significant differences between the groups regarding the incidence of VAP (21 of 217 [9.7 %] with toothbrushing vs. 24 of 219 [11.0 %] without toothbrushing; odds ratio [OR] = 0.87, 95 % confidence interval [CI] = 0.469–1.615; p = 0.75). Adding manual toothbrushing to chlorhexidine oral care does not help to prevent VAP in critical care patients on mechanical ventilation.

Chlorhexidine-silver sulfadiazine-impregnated venous catheters save costs

OBJECTIVE To analyze the efficacy of periodically changing ventilator circuits for decreasing the rate of ventilator-associated pneumonia when a heat and moisture exchanger (HME) is used for humidification. The Centers for Disease Control and Prevention recommended not changing the circuits periodically. DESIGN Randomized, controlled trial conducted between April 2001 and August 2002. SETTING A 24-bed, medical-surgical intensive care unit in a 650-bed, tertiary-care hospital. PATIENTS All patients requiring mechanical ventilation during more than 72 hours from April 2001 to August 2002. INTERVENTIONS Patients were randomized into two groups: (1) ventilation with change of ventilator circuits every 48 hours and (2) ventilation with no change of circuits. Throat swabs were taken on admission and twice weekly until discharge to classify pneumonia as endogenous or exogenous. RESULTS Three hundred four patients (143 from group 1 and 161 from group 2) with similar characteristics (age, gender, Acute Physiology and Chronic Health Evaluation II score, diagnostic group, and mortality) were analyzed. There was no significant difference in the rate of pneumonia between the groups (23.1% vs 23.0% and 15.5 vs 14.8 per 1,000 ventilator-days). There was no significant difference in the incidence of exogenous pneumonia per 1,000 days of mechanical ventilation (1.71 vs 1.25). There was no difference in the distribution of microorganisms causing pneumonia. CONCLUSIONS Circuit change using an HME for humidification does not decrease pneumonia and represents an unnecessary cost.

Rapid Legionella pneumophila determination based on a disposable core-shell Fe₃O₄@poly(dopamine) magnetic nanoparticles immunoplatform.

ObjectiveTo evaluate the efficacy of bacterial filters (BF) to decrease pneumonia associated with mechanical ventilation (MV). DesignProspective, randomized study. SettingA 24-bed medicosurgical intensive care unit in a 650-bed tertiary hospital. PatientsA total of 230 patients who needed MV for >24 hrs. InterventionsA total of 114 patients were ventilated with BF and 116 without BF. MeasurementsThroat swab and tracheal aspirate were taken at the moment of admission and twice a week until discharge. We considered the following infectious events: pneumonia, respiratory infection, which comprises pneumonia or tracheobronchitis, and respiratory colonization–infection complex, which comprises respiratory infection or colonization. All infectious events were classified as endogenous or exogenous based on throat flora. Main ResultsBoth groups of patients (ventilated with and without filters) were similar in age, sex, Acute Physiology and Chronic Health Evaluation II score, diagnostic group, days of MV, and mortality. There was no difference in the percentage of patients who developed pneumonia (24.56% with BF and 21.55% without BF), respiratory infection (33.33% vs. 28.44%), or colonization-infection (42.10% vs. 43.96%). The number of infectious events per 1000 days of MV were also similar in both groups: pneumonia (17.41 with BF and 16.26 without BF), respiratory infection (24.62 vs. 21.48), and colonization-infection (36.63 vs. 36). There were also no differences in incidence of infectious events by MV duration. Likewise, we did not find any differences in the number of exogenous events per 1000 days of MV: pneumonia, 2.40 with BF vs. 1.74 without BF; colonization-infection, 4.20 vs. 4.05. ConclusionsBacterial filters in ventilation circuits neither reduce the prevalence of respiratory infections associated with MV nor decrease exogenous infectious events; thus, their usage is not necessary.