Vent bundles and ventilator-associated pneumonia outcomes
Clinical question: Are the components of the ventilator bundles (VBs) associated with better outcomes for patients?
Background: VBs have been shown to prevent ventilator-associated pneumonia (VAP). However, most of the studies have analyzed outcomes based on the whole bundle without considering each individual component.
Study design: Retrospective cohort study.
Setting: Brigham and Women’s Hospital in Boston.
Synopsis: Individual VB components were investigated among 5,539 patients undergoing mechanical ventilation for at least three days. Outcomes reported were ventilator-associated events (VAEs), extubation alive versus ventilator mortality, and hospital discharge versus hospital death.
Spontaneous breathing trials were associated with lower hazards for VAEs (HR, 0.55; 95% CI, 0.40-0.76; P less than .001) and infection-related ventilator-associated complications (IVACs) (HR, 0.60; 95% CI, 0.37-1.00; P = .05). Head-of-bed elevation (HR, 1.38; 95% CI, 1.14-1.68; P = 0.001) and thromboembolism prophylaxis (HR, 2.57; 95% CI, 1.80-3.66; P less than .001) were associated with less time to extubation.
Oral care with chlorhexidine was associated with lower hazards for IVACs (HR, 0.60; 95% CI 0.36-1.00; P = .05) and for VAPs (HR, 0.55; 95% CI, 0.27-1.14; P = .11) but an increased risk for ventilator mortality (HR, 1.63; 95% CI, 1.15-2.31; P = .006). Stress ulcer prophylaxis was associated with higher risk for VAP (HR, 7.69; 95% CI, 1.44-41.10; P = .02).
Bottom line: Standard VB components merit revision to increase emphasis on beneficial components and eliminate potentially harmful ones.
Citation: Klompas M, Li L, Kleinman K, Szumita PM, Massaro AF. Association between ventilator bundle components and outcomes. JAMA Intern Med. 2016;176(9):1277-1283.
Dr. Mosetti is an assistant professor at the University of Miami Miller School of Medicine and a hospitalist at University of Miami Hospital and Jackson Memorial Hospital.
