Shifting the Paradigm: Preventing More Than Infection

Cawcutt, Kelly

doi:10.1017/ice.2018.87

Cited by 3 publications

(3 citation statements)

References 23 publications

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“…Less common events include pulmonary emboli, sepsis syndromes, stroke, transfusion-associated lung injury, radiation pneumonitis and abdominal compartment syndrome [28]. The enhanced scope of VAE surveillance is something that clinicians and quality advocates can understand and appreciate [8,29,30]. Indeed, the estimated odds of dying are about 50% higher for patients with VAE versus traditionally defined VAP (OR 1.5, 95% CI 1.1e2.0), reflecting the potential significance of the broader range of potentially iatrogenic events identified through VAE surveillance [22].…”

Section: Ongoing Uncertainty About the Vae Concept And How It Relates To Vapmentioning

confidence: 99%

Barriers to the adoption of ventilator-associated events surveillance and prevention

Klompas

2019

Clinical Microbiology and Infection

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The CDC expanded the purview of safety surveillance for ventilated patients from ventilator-associated pneumonia (VAP) to ventilator-associated events (VAE) in 2013. CDC created VAE definitions to simplify surveillance, increase objectivity, and broaden prevention efforts. Many U.S. hospitals are conducting VAE surveillance but uptake beyond the U.S. has been limited. Review of recent publications suggest three major barriers to the adoption of VAE surveillance and prevention: 1) ongoing uncertainty about VAE and concern about its limited overlap with clinically-defined VAP, 2) a paucity of studies defining risk factors for VAEs and how best to prevent VAEs, and 3) lack of emphasis on VAE surveillance and prevention by regulatory agencies. Emerging data partially address the first two points. Possible VAPs missed by VAE surveillance are associated with lower mortality rates than VAEs and have similar outcomes whether treated with 3 days of antibiotics or more conventional courses, suggesting VAE focuses surveillance on severe events. Potentially-modifiable VAE risk factors include deep sedation, positive fluid balance, blood transfusions, and mandatory modes of mechanical ventilation with high inspiratory pressures. Potential interventions to prevent VAEs include avoiding intubation, minimizing sedation, paired daily spontaneous awakening and breathing trials, conservative fluid management, conservative transfusion thresholds, low tidal volume ventilation, and early mobility. There are important limitations to all existing prevention studies, however, and no study has thus far has tested a VAE prevention bundle that includes all these interventions. Further work is needed to better define the clinical significance of VAPs missed by VAE surveillance, to rigorously evaluate the impact of an optimized VAE prevention bundle on VAEs and other outcomes, and to weigh whether these additional data provide adequate evidence to support mandating VAE surveillance and prevention.

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Section: Ongoing Uncertainty About the Vae Concept And How It Relates To Vapmentioning

confidence: 99%

Barriers to the adoption of ventilator-associated events surveillance and prevention

Klompas

2019

Clinical Microbiology and Infection

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“…This approach thereby broadens the definition of harm suffered by ventilated patients beyond pneumonia to include pulmonary edema, atelectasis, and acute respiratory distress syndrome. [24] The concept of VAEs has been validated and shown to be associated with longer MV duration and ICU and hospital stays and higher mortality[25262728293031]Objective outcome measures Mortality of mechanically ventilated patientsDuration of MV ICU length of stay…”

Section: National Approach To Standardize and Improve Mechanical Ventmentioning

confidence: 99%

National Approach to Standardize and Improve Mechanical Ventilation

et al. 2019

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NASAM (National Approach to Standardize and Improve Mechanical Ventilation) is a national collaborative quality improvement project in Saudi Arabia. It aims to improve the care of mechanically ventilated patients by implementing evidence-based practices with the goal of reducing the rate of ventilator-associated events and therefore reducing mortality, mechanical ventilation duration and intensive care unit (ICU) length of stay. The project plans to extend the implementation to a total of 100 ICUs in collaboration with multiple health systems across the country. As of March 22, 2019, a total of 78 ICUs have registered from 6 different health sectors, 48 hospitals, and 27 cities. The leadership support in all health sectors for NASAM speaks of the commitment to improve the care of mechanically ventilated patients across the kingdom.

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“…Currently, the available evidence-based guidelines support the viability of avoiding VAP with the concurrent use of certain medications (proton pump inhibitors, sucralfate, and antimicrobial prophylaxis) [14,15]. This approach is sometimes referred to as a VAP bundle.…”

Section: Introductionmentioning

confidence: 99%

Impact of Ventilator-Associated Pneumonia Preventative Measures and Ventilator Bundle Care in a Tertiary Care Hospital’s Adult Intensive Care Unit

Singh,

Abdullah

2024

Cureus

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Background: The mitigation of ventilator-associated pneumonia (VAP) is a vital undertaking in safeguarding patient well-being. The research aimed to evaluate the impact of a multidisciplinary, comprehensive monitoring approach on VAP incidence in a tertiary medical-surgical-trauma critical care unit.Methodology: The research was conducted within an adult medical-surgical ICU from June 2021 to December 2022. VAP data were collected by prospective targeted surveillance in accordance with the guidelines provided by the National Healthcare Safety Network (NHSN) and the Centers for Disease Control and Prevention. In contrast, a cross-sectional design was used to gather bundle data, according to the defined methodology of the Institute for Healthcare Improvement (IHI), and the rate of variation in admission prior to the bundle's installation was evaluated.Result: The features of ventilated patients in adult medical-surgical ICUs were studied between 2021 and 2022. Regarding demographics, men comprised 42.6% and 45.3% of VAP patients and 65.3% and 50.7% of bundle care patients, respectively. Notably, 33.1% of patients in VAP and 54.5% in bundle care were over 60 years old. Clinical indicators such as median age (12.6 vs. 8 months for non-VAP vs. VAP patients), antibiotic usage (65% vs. 99% for non-VAP vs. VAP patients), and risk factors like trauma diagnosis (HR: 2.59, 95% CI: 2.07-3.23), and accidental extubation (HR: 4.11, 95% CI: 1.93-8.73) differed significantly between the bundle and non-bundle care groups. A significant increase in bundle compliance was seen from 90% in 2021 to 97% in 2022 (P-value <0.001), which helped to lower VAP rates and highlight the need for ongoing quality improvement in ICU treatment. Conclusion:The use of ventilator bundles at a tertiary care hospital resulted in improvements in ventilator utilization, with an approximate increase of 20% and VAP rates of over 70% for adult critical patients.

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Shifting the Paradigm: Preventing More Than Infection

Cited by 3 publications

References 23 publications

Barriers to the adoption of ventilator-associated events surveillance and prevention

Barriers to the adoption of ventilator-associated events surveillance and prevention

National Approach to Standardize and Improve Mechanical Ventilation

Impact of Ventilator-Associated Pneumonia Preventative Measures and Ventilator Bundle Care in a Tertiary Care Hospital’s Adult Intensive Care Unit

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