DOI: 10.1097/01.SA.0000367830.98434.8d
,
Issn Print: 0039-6206
Publication Date: 2010/04/01
Facebook
Twitter
LinkedIn
Email
 |
Checking for direct PDF access through Ovid | |
Excerpt
F. Bloos,* S. Müller,* A. Harz,* M. Gugel,* D. Geil,* K. Egerland,* K. Reinhart,* and G. Marx*†
(Br J Anaesth, 103:232-237, 2009)
*Department of Anesthesiology and Intensive Care Medicine, University Hospital Jena, Jena; and †Department of Surgical Intensive Care Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Mechanically ventilated patients are at risk for development of infections, such as ventilator-associated pneumonia (VAP), and other complications, including deep vein thrombosis. These problems increase mortality rates, length of stay, and the costs of care. Investigators sought to determine whether staff training in predefined interventions (bundles) would improve quality of care and outcomes in mechanically ventilated patients.
The study setting was a 50-bed intensive care unit (ICU) at a tertiary care university hospital. Eligible postsurgical patients were at least 10 years old and had been mechanically ventilated for more than 24 hours. The bundle in this trial consisted of semirecumbent positioning of at least 30 degrees, lung-protective ventilation, stress ulcer prophylaxis, and deep vein thrombosis prophylaxis. For complete bundle adherence, all 4 elements were required in patients with acute lung injury (ALI), and all but lung-protective ventilation in those without ALI. Application of the bundle was assessed before and after staff training.
A total of 133 patients before and 141 patients after staff training were included in the evaluation. Overall adherence to the bundle increased from 15% before to 33.8% after training. Semirecumbent positioning was followed in 24.9% of patient-days before versus 46.9% of patient-days after staff training. Ulcer prophylaxis was performed at similarly high rates during both periods (94.5% and 94.9% of patient-days, respectively), and administration of deep vein thrombosis prophylaxis increased from 89.5% to 91.5%. Median tidal volume was unchanged in patients with ALI, and rates of VAP, ICU length of stay, and ICU mortality were not reduced. But patients had a mean of 2 fewer days on mechanical ventilation, and those with VAP had their median length of ICU stay shortened by 9 days.
Staff training led to a more than 2-fold increase in overall bundle adherence and fewer days on mechanical ventilation. Semirecumbent positioning improved, but was not universally followed. Higher compliance and success rates may require implementation of a continuous quality improvement process.
