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Efficacy of an expanded ventilator bundle for the reduction of ventilator-associated pneumonia in the medical intensive care unit

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The ventilator bundle (VB) includes a group of clinical maneuvers (head-of-bed elevation, “sedation vacation,” deep vein thrombosis prophylaxis, and peptic ulcer disease prophylaxis) to improve outcomes in patients undergoing mechanical ventilation. We modified the standard VB in our medical intensive care unit to include a group of respiratory therapist–driven protocols and, postimplementation, observed a statistically significant (P = .0006) reduction in ventilator-associated pneumonia (VAP), from a median of 14.1 cases/103 ventilator-days (interquartile range [IQR] = 12.1 to 20.6) to 0 cases/103 ventilator-days (IQR = 0 to 1.1).

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Setting

This study was conducted in the 18-bed adult MICU at St Joseph's Regional Medical Center, a 750-bed teaching hospital in northern New Jersey, which admitted a median of 15,277 adult patients (range, 15,133 to 15,538) during the years of this study. Between January 1, 2003 and December 31, 2007, the MICU admitted a median of 1056 patients/year (interquartile range [IQR] = 1001 to 1133), of whom roughly 35% underwent mechanical ventilation. All patients were age ≥ 18 years, with no upper age

Results

We used 2 approaches to examine the change in the rate of VAP before and after intervention. First, we compared the overall rate during the historical period with the rate for the postintervention observation period. These data, shown in Figure 1, demonstrate a statistically significant (P = .006) decrease from a median value of 14.1 cases/103 ventilator-days (IQR = 12.1 to 20.6; 95% confidence interval [CI] = 10.9 to 20.3) to a median of 0 cases/103 ventilator-days (IQR = 0 to 1.1; 95% CI = 0

Discussion

Spurred in part by the Institute for Healthcare Improvement's “100,000 Lives Campaign,” the medical community undertook the development of practice guidelines to improve outcomes related to a core group of preventable clinical conditions. Among these, VAP has attracted considerable attention, with the publication of at least 15 randomized controlled trials and 7 integrative systematic reviews and meta-analyses directed toward the goal of preventing this complication.9, 10

Fox11 has proposed a

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