Application of treatment bundles reduces days on mechanical ventilation in critically ill patients

Background

Reduction of time on the ventilator is a key concept to avoid complications. Recommendations include semirecumbent positioning (SRP) [1], low tidal volume ventilation (TV = 6 ml/kg) [2], prophylaxis for stress ulcer (SUP) [3], and deep vein thrombosis (DVTP) [4]. The goal of this study was to investigate whether staff training about these treatments decreases days on ventilation.

Methods

All patients of a 50-bed ICU with mechanical ventilation >24 hours were included. From June 2005 to September 2005 (Audit I), patients were examined daily for SRP >30°, low tidal volume ventilation, DVTP, and SUP by an independent task force. Afterwards, nurses and physicians were trained for the monitored treatments. Audit II was then performed from March 2006 to June 2006.

Results

One hundred and thirty-three patients (1,389 ventilator-days) were included in Audit I, 141 patients (1,002 ventilator-days) in Audit II. Data are expressed as the median (interquartile range) or percentage of implementation per ventilator-days (Table 1). On average, low tidal volume ventilation was adopted. DVTP and SUP were well implemented without training. There was no effect on frequency of pneumonia, ICU length of stay, or survival.

Table 1 (abstract P171)

Conclusion

SRP could be successfully improved by staff training. Enhanced implementation was associated with reduction in days on ventilation.