Ventilator circuit and secretion management strategies: A Franco-Canadian survey

Objective: To determine the use of ventilator circuit and secretion managem ent strategies in France and Canada. Design: Binational cross-sectional survey. Population: Intensive care unit (ICU) directors in French and Canadian univ ersity hospitals. Measurements: We compared responses between countries regarding the use of seven circuit and secretion strategies, the rationales against their use, d ecisional responsibility for these strategies, whether ventilator-associate d pneumonia (VAP) practice was audited, and whether VAP prevention guidelin es addressing these strategies were used. Results: The response rate was 72/84 (85.7%) for French and 31/32 (96.9%) f or Canadian ICUs. Endotracheal intubation was predominantly oral in both co untries. Changing the ventilator circuits only for every new patient was mo re frequent in France than in Canada (p < .0001). Heated humidifiers were u sed more in Canada than France (p = .0003). Closed endotracheal suctioning was used more frequently in Canada (p < .0001). In both countries, subglott ic secretion drainage and kinetic beds were rarely used. Semirecumbent posi tioning was reported more often by French than Canadian ICUs (p = .003). Re asons for nonuse of these strategies included adverse effects (heat and moi sture exchangers), cost (kinetic beds), lack of convincing benefit (subglot tic secretion drainage), and nurse inconvenience (semirecumbency). Decision al responsibility far each strategy differed among institutions, VAP preven tion practice was periodically reviewed in 53% of French and 68% of Canadia n ICUs (p = .20). VAP prevention guidelines were used in 64% and 30% of the se ICUs, respectively (p = .002). Conclusions: Our study does not support the notion that published recommend ations substantially impact reported use of several ventilator circuit and secretion management strategies. Based on the use of more frequent ventilat or circuit changes, closed suctioning systems, heated humidifiers, and resp iratory therapists, ventilator circuit and secretion management practice ap pears more costly in Canada than in France.