Value of implementing a care bundle approach to improve outcome of pediatric ventilator − associated events (PedVAE) in pediatric intensive care unit (PICU)

Abstract

Background Pediatric ventilator-associated events (PedVAEs) refer to a persistent deterioration in oxygenation following a period of stability, and these are valuable for monitoring and detecting issues arising from mechanical ventilation in children. However, the effectiveness of measures to reduce PedVAEs rates is still being determined. Objectives We aimed to evaluate the incidence of PedVAEs before and after implementation of a ventilator care bundle (VCB) in the pediatric intensive care unit (PICU). Methods We conducted a single-centre prospective comparative analysis on 323 mechanically ventilated patients admitted to the PICU from January 2022 to June 2023 (after the implementation of the VCB). From these patients, we selected those who met the CDC protocol diagnosis for PedVAEs (Group II). Prior to the implementation of the VCB, we retrospectively analysed the records of 108 patients from January 2021 to December 2021. We noted the complete blood count, C-reactive protein, procalcitonin, arterial blood gases, and endotracheal aspirate cultures of the patients. Results There was a significant decrease in the length of stay following a bundle implementation (P value < 0.05), with a mean of 10.9 (4.9) days before bundle and 8 (2.7) days after bundle. Following the bundle implementation, group II had 24% lower PedVAEs than group I (33%). In group II, mechanical ventilation complications were 25%, compared to 49% in group I. Conclusion Ventilator-associated event (VAE) is a consequence of mechanical ventilation that greatly lengthens the duration of stay in the PICU and increases the risk of mortality. The introduction of a bundle was found to be successful in reducing the rate of VAEs in patients in PICU.