Implementation of an Evidence-based Extubation Readiness Bundle in 499 Brain-injured Patients. A Before–After Evaluation of a Quality Improvement Project

Roquilly, Antoine; Cinotti, Raphaël; Jaber, Samir; Vourc’h, Mickaël; Pengam, Florence; Mahé, Pierre; Lakhal, Karim; Latte, Dominique Demeure Dit; Rondeau, Nelly; Loutrel, Olivier; Paulus, Jérôme; Rozec, Bertrand; Blanlœil, Y.; Vibet, Marie-Anne; Sebille, Véronique; Feuillet, Fanny; Asehnoune, Karim

doi:10.1164/rccm.201301-0116oc

Cited by 81 publications

(65 citation statements)

References 67 publications

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“…It is therefore interesting that a higher number of ventilation-free days was independently associated with a better outcome in our study. An evidence-based bundle is able to reduce the duration of mechanical ventilation in severely brain-injured-patients [43] but there is not yet enough data to assess the impact of such a strategy on the long-term neurological outcome.…”

Section: Discussionmentioning

confidence: 99%

Effects of tight computerized glucose control on neurological outcome in severely brain injured patients: a multicenter sub-group analysis of the randomized-controlled open-label CGAO-REA study

et al. 2014

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IntroductionHyperglycemia is a marker of poor prognosis in severe brain injuries. There is currently little data regarding the effects of intensive insulin therapy (IIT) on neurological recovery.MethodsA sub-group analysis of the randomized-controlled CGAO-REA study (NCT01002482) in surgical intensive care units (ICU) of two university hospitals. Patients with severe brain injury, with an expected ICU length of stay ≥48 hours were included. Patients were randomized between a conventional glucose management group (blood glucose target between 5.5 and 9 mmol.L−1) and an IIT group (blood glucose target between 4.4 and 6 mmol.L−1). The primary outcome was the day-90 neurological outcome evaluated with the Glasgow outcome scale.ResultsA total of 188 patients were included in this analysis. In total 98 (52%) patients were randomized in the control group and 90 (48%) in the IIT group. The mean Glasgow coma score at baseline was 7 (±4). Patients in the IIT group received more insulin (130 (68 to 251) IU versus 74 (13 to 165) IU in the control group, P = 0.01), had a significantly lower morning blood glucose level (5.9 (5.1 to 6.7) mmol.L−1 versus 6.5 (5.6 to 7.2) mmol.L−1, P <0.001) in the first 5 days after ICU admission. The IIT group experienced more episodes of hypoglycemia (P <0.0001). In the IIT group 24 (26.6%) patients had a favorable neurological outcome (good recovery or moderate disability) compared to 31 (31.6%) in the control group (P = 0.4). There were no differences in day-28 mortality. The occurrence of hypoglycemia did not influence the outcome.ConclusionsIn this sub-group analysis of a large multicenter randomized trial, IIT did not appear to alter the day-90 neurological outcome or ICU morbidity in severe brain injured patients or ICU morbidity.

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Section: Discussionmentioning

confidence: 99%

Effects of tight computerized glucose control on neurological outcome in severely brain injured patients: a multicenter sub-group analysis of the randomized-controlled open-label CGAO-REA study

et al. 2014

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“…No mortality differences were observed. The number of extubation-related complications was also not different between the two groups, but the rate of unplanned extubation was significantly lower in the intervention group (21).…”

Section: Editorialmentioning

confidence: 78%

“…Recent work has attempted to reconcile the specific aspects of neurological and neurosurgical critically ill patients with the general principles of critical care medicine. In a before-after study conducted in two ICUs of one university hospital, a multifaceted bundle was implemented in patients with brain injury to assess the efficacy in reducing the duration of MV (21). This 3-phase study enrolled 499 patients receiving MV for more than 24 hours.…”

Section: Editorialmentioning

confidence: 99%

“…All patients with brain injuries, as defined by GCS ≤12 combined with one or more acute processes visualized on brain computed tomography scan, were included in the study protocol. Likewise the previous study (21), during the pre-intervention phase the control group underwent treatment at the discretion of the attending physician (22). The staff of each ICU was then trained through a standardized educational program to implement a protocol consisting of LPMV with VT ≤7 mL/kg of PBW and PEEP ranging between 6 and 8 cmH 2 O.…”

Section: Editorialmentioning

confidence: 99%

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Mechanical ventilation in brain injured patients: seeing the forest for the trees

Bruni¹,

Garofalo²,

Pelaia³

et al. 2017

J. Thorac. Dis.

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“…Although the effectiveness of checklists depends on their implementation and the local environment in which they are implemented, the use of checklists and protocols has become commonplace to promote the timely, consistent delivery of high-quality care (3)(4)(5). Checklists help minimize complications of respiratory failure, improve mechanical ventilator management, decrease adverse events, and improve communication (6)(7)(8).…”

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confidence: 99%

Creation of the Prevention of Organ Failure Checklist. A Multidisciplinary Approach Using the Modified Delphi Technique

et al. 2016

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Rationale: Respiratory failure represents a major risk for morbidity and mortality. Although generally managed in the intensive care unit (ICU), respiratory failure often begins elsewhere. Checklists of care processes to minimize the duration of mechanical ventilation and adverse events are routinely used in the ICU, but are uncommonly used outside the ICU.Objectives: To develop consensus among a multidisciplinary expert panel on care practices to include in a checklist of best practices for critically ill patients with respiratory failure before and after ICU admission.Methods: A multidisciplinary expert panel was assembled. The panel was tasked with creating a checklist of care processes aimed at decreasing progression to respiratory failure, duration of mechanical ventilation, mortality in mechanical ventilation, and adverse events. Over the course of multiple teleconferences and e-mail communications, the Prevention of Organ Failure Checklist list was reviewed, refined, and voted upon. Items that received greater than 75% of the vote were included in the final checklist.Measurements and Main Results: Using a modified Delphi process, the expert panel was able to compile Prevention of Organ Failure Checklist into 20 items that aimed to decrease mechanical ventilation by assessing the causes of acute respiratory failure, ventilation strategies, sedation, and general critical care processes, as well as to avoid unwanted or nonbeneficial interventions. Conclusions:The modified Delphi process identified readily available preventative interventions suitable for checklist implementation in patients with or progressing to respiratory failure even before ICU admission.

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Implementation of an Evidence-based Extubation Readiness Bundle in 499 Brain-injured Patients. A Before–After Evaluation of a Quality Improvement Project

Abstract: The implementation of an evidence-based extubation readiness bundle was associated with a reduction in the duration of ventilation in patients with brain injury.

Cited by 81 publications

References 67 publications

Effects of tight computerized glucose control on neurological outcome in severely brain injured patients: a multicenter sub-group analysis of the randomized-controlled open-label CGAO-REA study

Effects of tight computerized glucose control on neurological outcome in severely brain injured patients: a multicenter sub-group analysis of the randomized-controlled open-label CGAO-REA study

Mechanical ventilation in brain injured patients: seeing the forest for the trees

Creation of the Prevention of Organ Failure Checklist. A Multidisciplinary Approach Using the Modified Delphi Technique

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