Mechanical ventilation with or without 7-day circuit changes: a randomized controlled trial

Article Abstract:

Replacing the ventilator circuits of patients on mechanical ventilators only when necessary may reduce medical costs without posing an increased risk for developing pneumonia. Ventilator circuits consist of tubing, a device for administering medicine, fittings, and a humidifier. Researchers evaluated the safety and cost-effectiveness of replacing ventilator circuits only when necessary with routine weekly changes in patients on mechanical ventilators. Thirty-six (24.5%) of the 147 patients with no routine ventilator circuit replacement developed pneumonia. Forty-four (28.8%) of the 153 patients with routine ventilator circuit replacement developed pneumonia. Patients with a tracheostomy developed more cases of pneumonia with routine replacement of their ventilator circuits. The total cost of routinely changing the ventilator circuits was $7,410. The total cost of replacing the circuits only when necessary was $330.

Maintenance and repair, Ventilators, Ventilators (Medical equipment)

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The safety and diagnostic accuracy of minibronchoalveolar lavage in patients with suspected ventilator-associated pneumonia

Article Abstract:

Minibronchoalveolar lavage appears to be a safe and effective method for collecting samples for culture from the lungs. The procedure involves passing a catheter through a ventilated patient's endotracheal tube, washing a small passage within the lung with saline, and sucking up the fluid for culturing. Another procedure, protected specimen brush technique, involves passing a bronchoscope through an endotracheal tube and collecting lung fluid. Seventy-two patients suspected of having ventilator-associated pneumonia had minibronchoalveolar lavage, and 42 of these also had the protected specimen brush procedure. Complications were more common with the protected specimen brush procedure. The two techniques agreed in the diagnosis of pneumonia 83% of the time. The lavage technique does not require a doctor to perform it and saves about $1,000 per procedure.

Evaluation, Diagnosis, Complications and side effects, Artificial respiration, Mechanical ventilation, Bronchoalveolar lavage

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Hospital-wide restriction of clindamycin: effect on the incidence of Clostridium difficile-associated diarrhea and cost

Article Abstract:

Restricting the use of the antibiotic clindamycin can reduce the incidence of diarrhea caused by Clostridium (C.) difficile, which can lead to lower hospital costs. C. difficile is responsible for about 25% of all cases of diarrhea in hospitals. After one hospital placed restrictions on the use of clindamycin, the number or cases of diarrhea due to C. difficile dropped from an average of 11.5 cases per month to 3.3 cases per month. Sixty-one percent of the bacterial isolates were sensitive to clindamycin, compared to only 9% before the drug was restricted.

Health aspects, Diarrhea, Clostridium infections, Clindamycin

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