The association of ventilator-associated pneumonia with the frequent exchange of endotracheal tube

Background: In endotracheal intubated patients, the prolonged presence of an endotracheal tube (ETT) and mechanical ventilation support is associated with increased risk of ventilator associated pneumonia (VAP). The aim of this study was to investigate whether it is safe to prolong the use of the endotracheal tube without causing an increase in the incidence of VAP in patients under long term mechanical ventilator support. Materials and methods: Eleven prolonged mechanical ventilation (PMV) patients were recruited from respiratory care wards (RCW) and divided into two groups by randomized complete block design. ETT was changed either every 30 days (control group) or 90 days (experiment group). The incidence of VAP and cumulative rate of patients remaining free of VAP were assessed. Results: A total of 48 times of ETT changes were completed in 11 patients. The incidence of VAP were 8.8% (3/34 times) in the control group and 42.9% (6/14 times) in the experiment group (P = 0.01). The cumulative rate of patients remaining free of VAP probability was higher in the group of routinely changed every 30 days during the study period (P = 0.002). There were no statistically significant differences between the two groups including microorganisms that caused VAP, disease severity classification at VAP onset, transferred to ICU and hospital mortality. Conclusions: Routine 30-day change of ETT could reduce the incidence of VAP but it should be weighed on the possible risk of airway trauma during the invasive procedure.