Complete Closed-Loop Ventilatory Circuit Delays the Onset of Ventilator-Associated Pneumonia in Mechanically Ventilated Neurological Patients in the ICU: A Single-Center Prospective Preliminary Study

Abstract

Abstract Background Ventilator-associated pneumonia (VAP) is preventable yet its incidence remains high. We compared conventional ventilator circuit with open suction and dual heated wire circuit (DHWC) with closed suction on the incidence of VAP. Methods This is a single-center, prospective cohort study conducted at a tertiary care hospital in neurological patients admitted to the neuro-intensive care unit (neuro-ICU) and requiring mechanical ventilation (MV) for more than 48 hours. Patients were ventilated using either conventional ventilator circuit with open suction (open group) or DHWC with closed suction (closed group) and were observed for VAP during the first 14 days of MV. The incidence and day of onset of VAP, duration of MV, duration of neuro-ICU and hospital stay, and mortality was noted in each group. Results A total of 63 patients were included (32 in open and 31 in closed group). The incidence of VAP was 9.3% in the open group and 12.9% in the closed group (p = 0.8). All the patients developed late VAP, that is, > 96 hours after intubation. However, as compared to the open group, VAP was observed much later in the closed group (day 7 vs. day 11). Duration of MV, neuro-ICU stay, hospital stay, and mortality did not differ significantly. Conclusion In this study, VAP incidences are similar in both the groups. However, neurological patients requiring MV for a short period might benefit from the usage of DHWC with closed suction system as VAP was seen to occur later in this group. Further, a randomized controlled trial with larger sample size is desired to confirm our findings.