Changing heat and moisture exchangers every 48 hours rather than 24 hours does not affect their efficacy and the incidence of nosocomial pneumonia.

Djedaïni, Kamel; Billiard, Michel; Mier, Laurence; Bourdellès, Geneviève Le; Brun, Patrick; Markowicz, Philippe; Estagnasié, Philippe; Coste, F; Boussougant, Y; Dreyfuss, Didier

doi:10.1164/ajrccm.152.5.7582295

Cited by 83 publications

(41 citation statements)

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“…No entanto, vários estudos questionam a frequência da troca e seu uso prolongado por mais que 24 horas 22,23,25 . Djedaini et al 29 mostraram que as propriedades de filtro bacteriológico de um FTCU não foram modificadas com o uso por 48 horas e que a incidência de PAV foi idêntica entre indivíduos que usaram por 24 ou 48 horas.…”

Section: Discussionunclassified

Trocador de calor e umidade: proteção contra infecções pulmonares? Estudo piloto

Alcoforado¹,

Paiva²,

Silva³

et al. 2012

Fisioter. Pesqui.

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| The aim of this study was to conduct a bacteriological research comparing the aqueous heated humidification systems (HH) and filter heat and moisture exchanger (FHME) and to bacterial colonization and the incidence of respiratory infection in patients undergoing mechanical ventilation. It is a prospective, controlled trial, in that 15 intensive care unit (ICU) patients were divided into two groups. The first made use of HH (n=7) and the other, FHME (n=8). We collected samples of tracheal secretions, and condensate circuit FHME at admission in the fourth and eighth day and bacteriological analysis of the same place. Regarding the anthropometric characteristics, no differences were observed between the groups. The prevalence of ventilator associated pneumonia (VAP) was 57.1% in the HH and 62.5% in FHME. When performing quantitative bacteriological analysis between the group and HH and FHME, differences were not observed, suggesting no variation in the prevention of VAP between the humidification systems, but the presence of these bacteria in the tracheal and condensate and in the absence of these membrane FHME may indicate that the main source of contamination is the patient himself.Keywords | respiration, artificial; humidity; ventilators, mechanical; pneumonia, ventilator-associated; respiratory protective devices.RESUMO | O objetivo deste trabalho foi realizar um estudo bacteriológico comparativo entre os sistemas de umidificação aquoso aquecido (UAA) e filtro trocador de calor e umidade (FTCU) quanto à colonização bacteriana e a incidência de infecção respiratória em pacientes submetidos à ventilação mecânica (VM). Trata-se de uma pesquisa prospectiva, controlada e randomizada, na qual 15 pacientes internados na Unidade de Terapia Intensiva (UTI) foram distribuídos em dois grupos. O primeiro fez uso de UAA (n=7) e o outro de FTCU (n=8). Foram coletadas amostras da secreção traqueal, condensado do circuito e FTCU na admissão do paciente, no quarto e oitavo dias, e realizada análise bacteriológica dos mesmos. Quanto às características antropométricas, não observou-se diferenças entre os grupos estudados. A prevalência de pneumonia associada à ventilação (PAV) foi de 57,1% no UAA e 62,5% no FTCU. Ao realizar a análise bacteriológica quantitativa entre eles, não foram observadas variações, sugerindo não haver diferença na prevenção de PAV entre os sistemas de umidificação; porém a presença das mesmas bactérias na secreção traqueal e no condensado e ausência destas na membrana do FTCU podem indicar que a principal fonte de contaminação é o próprio paciente.Descritores | respiração artificial; umidade; ventiladores mecânicos; pneumonia associada à ventilação mecânica; dispositivos de proteção respiratória.

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Section: Discussionunclassified

Trocador de calor e umidade: proteção contra infecções pulmonares? Estudo piloto

Alcoforado¹,

Paiva²,

Silva³

et al. 2012

Fisioter. Pesqui.

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“…We postulate that it may have some relation to a change in the humidification protocol. At the end of 1996, in an attempt at decreasing costs, we started using HMEFs for 48 h instead of the previous more conventional 24 h. This practice of using HMEFs for 48 h has been found to be safe [15,16,17,18] and recent evidence suggest that the use for 96 h too may be safe [19]. The authors of the above studies, however, conceded the need for larger studies.…”

Section: Discussionmentioning

confidence: 99%

Changing patterns of airway accidents in intubated ICU patients

et al. 2000

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We noted a change of the pattern of airway accidents. We noted an increasing trend in the incidence of blocked tracheal tubes, associated with an increased duration of heat and moisture exchanger-filters use. We also noted that the incidence of tracheostomy tube accidents was similar to that of ETT accidents in the current study, unlike the earlier study where tracheostomy tube accidents were more frequent than ETT accidents. This was due to the elimination of tracheostomy tube displacements during the later study period. We associated this with the use of adjustable tracheostomy length tubes.

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“…The antimicrobial prescription policy, which was systematically applied by medical staff, was to prescribe the narrowest-spectrum antibiotic as soon as the susceptibility of the causative bacteria became known. For all patients, a heat-moisture exchanger was positioned between the Y-piece and the patient and was changed every 48 h [10]. The oropharyngeal cavity was carefully cleaned with antiseptic solution (hexamedine) 4 times daily.…”

Section: Study Populationmentioning

confidence: 99%

Pseudomonas aeruginosaVentilator‐Associated Pneumonia: Comparison of Episodes Due to Piperacillin‐Resistant versus Piperacillin‐Susceptible Organisms

Trouillet¹,

Vuagnat²,

Combes³

et al. 2002

CLIN INFECT DIS

160

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We sought to determine the epidemiological characteristics of patients in an intensive care unit (ICU) who developed ventilator-associated pneumonia (VAP) caused by piperacillin-resistant Pseudomonas aeruginosa (PRPA; n=34) or piperacillin-susceptible P. aeruginosa (PSPA; n=101). According to univariate analysis, the factors associated with the development of PRPA VAP were presence of an underlying fatal medical condition, immunocompromised status, longer previous hospital stay, less-severe illness at the time of ICU admission, duration of mechanical ventilation before onset of VAP, number of classes of antibiotic received, and previous exposure to imipenem or fluoroquinolone. Multivariate logistic regression analysis identified the following significant independent factors: presence of an underlying fatal medical condition (odds ratio [OR], 5.6), previous fluoroquinolone use (OR, 4.6), and initial disease severity (OR, 0.8). We concluded that the clinical characteristics of patients who develop PRPA VAP differ from those of patients who develop PSPA VAP. Restricted fluoroquinolone use is the sole independent risk factor for PRPA VAP that is open to medical intervention.

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Changing heat and moisture exchangers every 48 hours rather than 24 hours does not affect their efficacy and the incidence of nosocomial pneumonia.

Cited by 83 publications

References 0 publications

Trocador de calor e umidade: proteção contra infecções pulmonares? Estudo piloto

Trocador de calor e umidade: proteção contra infecções pulmonares? Estudo piloto

Changing patterns of airway accidents in intubated ICU patients

Pseudomonas aeruginosaVentilator‐Associated Pneumonia: Comparison of Episodes Due to Piperacillin‐Resistant versus Piperacillin‐Susceptible Organisms

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