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In order to reduce the contamination in the ventilator, bacterial filters were placed on the expiratory limb of a ventilator circuit. Aerosolized mucolytic agents may increase the resistance of the ventilator. The goal of this study is to determine the impact of aerosolized mucolytic agents on the pressure change during mechanical ventilation. Methods: A lung model was investigated with mucolytic inhaled agents of 10% acetylcysteine and 2% hypertonic saline. The agents were administered using a jet nebulizer every 45 minutes for 15 minutes. The pressure drop was measured after nebulization. The end point was referred to the 45th dose or obstruction of the filter. Furthermore, the pressure drop after steam autoclaving was also measured. Results: The maximum pressure was significantly higher with 10% acetylcysteine than with 2% sodium chloride (39.32 ± 7.22 cmH2O vs. 3.53 ± 0.90 cmH2O, p

Study Objectives: To compare the efficacy of two different types of Heat and Moisture Exchangers (HME filters) in reducing transmission of infection from the patient to ventilator and vice versa and also its cost effectiveness. Design: Randomized, controlled, double blind, prospective study. Patients and Methods: 60 patients admitted to the ICU from May 1, 2007 to July 31, 2007 of either sex, age ranging between 20 and 60 years, requiring mechanical ventilation were screened for the study. Following intubation of the patients, the HME device was attached to the breathing circuit randomly by the chit-in-a box method. The patients were divided into two groups according to the HME filters attached. Results: Both the groups were comparable with respect to age and sex ratio. In Type A HME filters, 80% showed growth on the patient end within 24 h and in 27% filters, culture was positive both on the patient and the machine ends. The organisms detected were Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa and co-related with the endotracheal aspirate culture. After 48 h, 87% filters developed organisms on the patient end, whereas 64% filters were culture positive both on the patient and the machine end. In Type B HME filters, 70% showed growth on patient′s end after 24 h. Organisms detected were S. aureus, E. coli, P. aeruginosa and Acinetobacter. Thirty percent of filters were culture negative on both the patient and machine ends. No growth was found on the machine end in any of the filters after 24 h. After 48 h, 73% of the filters had microbial growth on the patient end, whereas only 3% filters had growth (S. aureus) on the machine end only. Seven percent had growth on both the patient as well as the machine ends. The microorganisms detected on the HME filters co-related with the endotracheal aspirate cultures. Conclusion: HME filter Type B (study group) was significantly better in reducing contamination of ventilator from the patient as compared to Type A (control group), which was routinely used in our ICU. Type B filter was found to be effective for at least 48 h. This study can also be applied to patients coming to emergency department (ED) and requiring emergency surgery and postoperative ventilation; and trauma patients like flail chest, head injury etc. requiring ventilatory support to prevent them from acquiring ventilator-associated pneumonia (VAP).

Background/Purpose In order to reduce the contamination in the ventilator, bacterial filters were placed on the expiratory limb of a ventilator circuit. Aerosolized mucolytic agents may increase the resistance of the ventilator. The goal of this study is to determine the impact of aerosolized mucolytic agents on the pressure change during mechanical ventilation. Methods A lung model was investigated with mucolytic inhaled agents of 10% acetylcysteine and 2% hypertonic saline. The agents were administered using a jet nebulizer every 45 minutes for 15 minutes. The pressure drop was measured after nebulization. The end point was referred to the 45 th dose or obstruction of the filter. Furthermore, the pressure drop after steam autoclaving was also measured. Results The maximum pressure was significantly higher with 10% acetylcysteine than with 2% sodium chloride (39.32 ± 7.22 cmH 2 O vs. 3.53 ± 0.90 cmH 2 O, p < 0.001). With acetylcysteine filters, the pressure drop over 4 cmH 2 O occurred earlier and had a good relationship between the degree of pressure drop and doses. The acetylcysteine group yielded a significant difference in the pressure drop compared to the newly autoclaved and the end point of inhalation ( p = 0.043). Conclusion This study demonstrated the aerosolized mucolytic agents could increase the pressure drop of the bacterial filters during mechanical ventilation. The pressure drop of the bacterial filters was higher with 10% acetylcysteine. It is critical to continuously monitor the expiration resistance, auto-positive end-expiratory pressure, and ventilator output waveform when aerosolized 10% acetylcysteine was used in mechanical ventilation patients. [ABSTRACT FROM AUTHOR]

Aim: In this study, the effectiveness of disinfection with 2 % gluteraldehide of reusable ventilator circuits was investigated as well as the evaluation of whether bacterial filter protects against bacterial production with the use of laryngeal mask or endotracheal tube. Materials and Method: Onehundred and ningtyeight samples were taken from the reusable ventilator circuits disinfected daily with 2% gluteraldehide. Samplings were done from connection of filter and tracheal tube (Group FTT), tracheal tube without filter (Group TT), filter and laryngeal mask (Group FLM), laryngeal mask without filter (Group LM) and from the Y part of circuit, after disinfection (Group SS), and implanted into culture medium and transferred to the laboratory immediately. The length of time of use and the number of patients that the circuit was used after its disinfection were also recorded. Results: Bacterial production was observed in 64 samples out of 198 (32.3 %). Rate of bacterial growth was highest in Group LM with a rate of 85,0 % and lowest in Group SS with 6,9 %. Use of filter and tracheal tube decreased contamination compared to the use of without filter and use of laryngeal mask (p=0,009; p=0,015). Rate of contamination was independent of time of use but was correlated with the number of patients the circuit was used in. Especially in the circuits which were used in more than two patients, bacterial contamination was increased (p=0,001). Conclusion: Cold sterilization with 2 % gluteraldehide proved to be ineffective for reusable ventilator circuits as was shown by bacterial growth at a rate of 6,9 %. Although the use of disposable filter and tracheal tube decreased bacterial growth, we propose that reusable circuits seem unsafe in terms of bacterial contamination. [ABSTRACT FROM AUTHOR]

Introduction: Daily change of breathing circuits in the operating theatre requires a lot of resources and is time and labour consuming. The extended use of breathing circuits could reduce the workload of the staff and health care costs. The aim of the present study was to evaluate the contamination rate of anaesthesia breathing circuits changed after 24, 48 or 72 h of use. Materials: The study was performed as an experimental observational study. Microbiological samples were taken from 112 breathing systems including both parts of the ventilator circuit (inspiration and expiration) and analysed using microbiological standard techniques. Breathing circuits were changed according to three different schedules. In the 24-h group, breathing circuits were changed every day, whereas in the 48-h group changing of the circuits took place on Mondays, Wednesdays and Fridays. A period of 72 h operating use was tested on weekends. Results: A total of 112 breathing systems comprised of 224 samples from the ventilator circuit were tested for bacteria and yeast contamination. A non-significant increase in the contamination rate was observed with the extended use for breathing circuits (24 h: 3.33%, 48 h: 4.35% and 72 h: 5.56%; P for trend=0.66). Similarly, no significant increase in contamination rate could be observed at the sample level (24 h: 1.67%, 48 h: 3.26% and 72 h: 2.78%; P for trend=0.71). Conclusion: The extended use of breathing circuits for 48 and 72 h does not increase significantly the risk of contamination, provided that HME filters are changed separately for every patient. [ABSTRACT FROM AUTHOR]

Aims: The use of ultrapure dialysate decreases hemodialysis patients' morbidity. Bacterial and endotoxin content of reverse osmosis (RO) water is usually lowered or eliminated by a combination of bacterial filtration and regular disinfection of the distribution. Whether bacterial filtration may be replaced by UV irradiation is unknown. Materials and methods: One, and subsequently two UV lamps were inserted in a complex RO water distribution circuit, devoid of bacterial filters. RO water bacterial content was checked weekly between RO water distribution disinfections. Results: With one UV lamp on the departure of the RO water circuit, bacterial results remained negative (<1 cfu/ ml) till the second week after disinfection. Disinfection of the circuit was required every four weeks to comply with the AAMI Guidelines (<200 cfu/ml). Failure of the lamp was followed by bacterial growth (up to 500 cfu/ml), promptly aborted after replacement of the failed lamp. Subsequent addition of a second UV lamp on the return line of the water circuit kept bacteria <1 cfu/ml for up to five weeks. Endotoxin levels remained <0.125 EU. Conclusions: UV irradiation preserves a low RO water bacterial/endotoxin content in the distribution line and is not associated with a measurable endotoxin increase. [ABSTRACT FROM AUTHOR]

Lung function measurements with and without a disposable bacterial filter were compared in 60 children. Although statistically significant, the reduction of lung function measurements caused by using bacterial filters was small and clinically irrelevant (2-4% of predicted for forced expiratory volume in one second and vital capacity). [ABSTRACT FROM AUTHOR]

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