Training in ventilator bundle reduces days spent on mechanical ventilation
MedWire News: Staff training by an intensive care unit (ICU) change team in pre-defined interventions (bundle) improves the quality of care in mechanically ventilated patients, say researchers.
The ventilator bundle consisted of semirecumbent positioning, lung protective ventilation, ulcer prophylaxis, and deep vein thrombosis prophylaxis (DVTP) in patients with acute lung injury (ALI).
The study, performed on a 50-bed ICU of a tertiary care university hospital, showed that for a total of 133 patients audited before training was conducted, compliance with the elements of the bundle was poor.
Staff training, however, increased overall bundle adherence two-fold, from 15.0% to 33.8%.
For the 141 patients audited after staff training, semirecumbent position was achieved in 46.9% of patient days, compared with 24.9% before training. Administration of DVTP increased from 89.5% to 91.5%, while ulcer prophylaxis of more than 90.0% was achieved in both groups.
Frank Bloos (University Hospital Jena, Germany) and colleagues note in the British Journal of Anaesthesia that adherence to low tidal ventilation in patients with ALI remained unaltered by training, however.
“As we tried to implement a bundle with four separate treatments, the training relating to lung-protective ventilation may have remained relatively unnoticed in comparison with the other three treatments,” they suggest.
Despite incomplete bundle implementation, the improved compliance significantly reduced days on mechanical ventilation from 6 to 4. It also significantly reduced ICU length of stay among patients with ventilator-associated pneumonia (VAP) by 9 days.
But the rate of VAP, overall ICU length of stay, and ICU mortality remained unaffected by the improved ventilator bundle compliance.
The researchers suggest that the lack of effect on VAP rate may be due to variable effects of semirecumbent positioning on VAP rates and the fact that diagnosing VAP is difficult with no accurate diagnostic criteria among other factors.
They conclude: “Implementation of a ventilator bundle through staff training by an ICU change team improved compliance to a pre-defined ventilator bundle and reduced days on mechanical ventilation.”
The team adds: “Incompleteness of adherence indicates the fact that higher success rates may only be achieved by a continuous quality improvement process.”
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By Lucy Piper