Comparison of ventilator-associated pneumonia in children using disposable and nondisposable ventilator circuits

Abstract

Aims: The aim of the study was to compare the incidence of ventilator-associated pneumonia (VAP), mortality, and ventilator circuit-related cost associated with patients using disposable ventilator circuit to those associated with patients using nondisposable ventilator circuit. Setting and Design: A prospective randomized controlled study in a 10-bed Pediatric Intensive Care Unit at Queen Sirikit National Institute of Child Health between November 2011 and October 2012. Subjects and Methods: Children aged 1 month to 18 years who were ventilated >48 h were enrolled. Patients were randomized to be ventilated with a disposable or nondisposable heated wire ventilator circuit. Statistical Analysis Used: Statistical analysis was performed using SPSS version 17.0. The P < 0.05 was considered statistically significant. Results: Ninety-eight patients were enrolled. Of these, 48 were administered the disposable ventilator circuit, whereas 50 were administered the nondisposable ventilator circuit. The VAP rate was 20.53/1000 ventilator days for the former (n = 7) compared to 30.77/1000 ventilator days (n = 12) for the latter (odds ratio: 1.85; 95% confidence interval: 0.66–5.19, P = 0.24). The mortality rates were 2.1% in the disposable and 12% in the nondisposable circuit groups (P = 0.06). The unit cost of the disposable circuit (US dollar [USD] 51.60) was higher than that of the nondisposable circuit (USD 37.90). However, the total cost for the nondisposable group was higher due to the required use of more units (63 circuits for the disposable group vs. 95 circuits for the nondisposable group). Conclusions: The type of ventilator circuit is not likely to affect the VAP rate and mortality in children. The unit cost of a disposable circuit is higher than that of a nondisposable circuit. The total cost depends on the number of circuits used in each patient.