Effects of different frequencies of ventilator circuit changes on the incidence of ventilator-associated pneumonia: A network meta-analysis

Objective

To investigate the effect of different frequencies of ventilator circuit changes on the occurrence of ventilation-associated pneumonia using network meta-analysis.

Methods

Chinese and English databases were systematically searched to collect eligible studies on the relationship between ventilator circuit changes and ventilation-associated pneumonia. The incidence of pneumonia for each change frequency was pooled using R software, and network meta-analysis was performed using Stata software to determine the optimal change frequency.

Results

A total of 23 studies were included, including nine ventilator circuit changes with different frequencies. The meta-analysis showed that the combined incidence of pneumonia was 25 %. Network meta-analysis showed 3-day circuit changes significantly reduced ventilation-associated pneumonia incidence compared with 1 day (odds ratio (OR) = 0.26, 95 % confidence interval (CI) [0.10, 0.69]), 2 days (OR = 0.41, 95 % CI [0.20, 0.87]), 4 days (OR = 0.17, 95 % CI [0.04, 0.72]), and 14 days (OR = 0.11, 95 % CI [0.02, 0.50]). Direct meta-analysis showed no significant difference in 3-day circuit changes versus 1 day, 3-day circuit changes versus 14 days, and 7-day circuit changes versus 14 days. The probability ranking indicated that a 3-day frequency of ventilator circuit changes had the greatest probability of being the optimal intervention, followed by 5 days and 7 days.

Conclusion

The meta-analysis showed that ventilator circuit changes every 3 days had the best effect, but once a week also showed a positive preventive effect, with no significant effect on ventilation-associated pneumonia occurrence. These findings combined with existing evidence indicate that high frequency changes in the ventilator circuit should be avoided.