Published ahead of print on August 26, 2005, doi:10.1164/rccm.200408-1028OC Am. J. Respir. Crit. Care Med., Volume 172, Number 10, November 2005, 1276-1282 A more recent version of this article appeared on November 15, 2005
Submitted on August 9, 2004 Impact of Humidification Systems on Ventilator-associated Pneumonia: a Randomized Multicentre TrialJean-Claude Lacherade1,1 Medical ICU, Henri Mondor Hospital, Creteil, France, 2 Infectious Diseases ICU, Bichat Claude Bernard Hospital, Paris, France, 3 Surgical ICU and Anesthesiology Department, Henri Mondor Hospital, Creteil, France, 4 Neuro-Surgical ICU and Anesthesiology Department, Henri Mondor Hospital, Creteil, France * To whom correspondence should be addressed. E-mail: laurent.brochard{at}hmn.aphp.fr.
Rationale and objectives: The respective influence on the incidence of ventilator-associated pneumonia of currently available systems used for warming and humidifying the gases delivered to a mechanically ventilated patient, i.e., heated humidifiers and heat and moisture exchanger filters, remain controversial. Methods: we addressed this question in a multicenter randomized study comparing heated humidifiers (with heated circuits) and filters in an unselected population of 369 intensive care patients receiving mechanical ventilation for more than 48 hours. Main measurements and results: The diagnosis of pneumonia was confirmed using strict microbiologic criteria. There was no difference in pneumonia rate between the two groups [53/184 (28.8%) vs. 47/185 (25.4%) for humidifiers vs. filters; p=0.48], or in the incidence density of pneumonia [27.4/1000 ventilatory-days vs 25.3/1000 ventilatory-days for humidifiers vs. filters; p=0.76]. The mean duration of mechanical ventilation did not differ between the two groups [14.9 ± 15.1 vs 13.5 ± 16.3 days for humidifiers vs. filters, p=0.36]. Endotracheal tube occlusion occurred respectively in 5 and 1 patients in the humidifier and filter groups (p=0.12). Intensive care mortality was identical in the two groups (about 33%). Conclusion: these results suggest that both heated humidifiers and heat and moisture exchanger filters can be used with no significant impact on the incidence of ventilator-associated pneumonia and that other criteria may justify their choice. Key words: nosocomial pneumonia, airway occlusion, randomised controlled trial, infection
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