1 / 32

Preventing VAP - evidence for a care bundle

Preventing VAP - evidence for a care bundle. VAP. Incidence ~ 1 0 - 30% ventilated patients 7-15 / 1000 ventilator days Atributable mortality of 0-50% Atributable increase LOS of ~ 3 weeks. Prevent VAP Care Bundle. Reduce time on ventilator: Assess sedation requirements daily

andrew
Download Presentation

Preventing VAP - evidence for a care bundle

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Preventing VAP - evidence for a care bundle

  2. VAP • Incidence ~ 10 - 30% ventilated patients 7-15 / 1000 ventilator days • Atributable mortality of 0-50% • Atributable increase LOS of ~ 3 weeks

  3. Prevent VAP Care Bundle Reduce time on ventilator: • Assess sedation requirements daily • Assess suitability for weaning and extubation daily While on ventilator: • Semi-recumbent positioning • Oral chlorhexidine • ? Subglottic drainage

  4. 128 ventilated patients Randomised: daily sedation break and titration v. standard care Outcomes: duration of ventilation, ICU & hospital stay

  5. p=0.19 p=0.02 p=0.004 Ventilator ICU Hospital

  6. Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Brook AD, Ahrens TS, Schaiff R et al Crit Care Med.1999;27:2609-15 321 ventilated patients Randomised: nurse-led sedation protocol v. standard care Outcomes: duration of ventilation, ICU & hospital stay

  7. Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Brook AD, Ahrens TS, Schaiff R et al Crit Care Med.1999;27:2609-15 P<0.001 P=0.013 P=0.003

  8. 300 ventilated patients Randomised: daily weaning trial v. standard care Outcomes: duration of ventilation, ICU & hospital stay

  9. RCT of protocol-directed v. physician-directed weaning from mechanical ventilation. Kollef MH, Shapiro SD, Silver P et al.Crit Care Med. 1997; 25:567-74

  10. RCT of protocol-directed v. physician-directed weaning from mechanical ventilation. Kollef MH, Shapiro SD, Silver P et al.Crit Care Med. 1997; 25:567-74

  11. Avoiding Ventilation • Daily sedation titration and weaning protocols will reduce ventilator days and ICU stay • VAP may be less common

  12. 86 ventilated patients • VAP in • 23% supine patients • (28.4/1000 Vent d) • v. • 5% semi-recumbent • (7.3/1000 Vent d) • NNT (95%CI) = 6 (3-23)

  13. Semi-recumbency • 45o head-up tilt is very difficult to achieve • No benefit of semi-recumbency ~30o over standard care ~10o • Supine position is harmful

  14. Oro-pharyngeal Antiseptics

  15. Crit Care Med 2007; 35:595–602

  16. Subglottic drainage • In patients expected to be ventilated > 3 days • In patients to be intubated de novo • Halves the risk of VAP • NNT = 8 (95% CI 5-15) • Shortens ventilation 2 days & ICU stay 3 days

  17. Prevent VAP Care Bundle • Assess sedation requirements daily • Assess suitability for weaning and extubation daily • Semi-recumbent position • Oral chlorhexidine • ? Subglottic drainage

  18. Do VAP prevention programmes work? Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia. Zack JE et alCrit Care Med 2002; 30: 2407-12 An educational intervention to reduce VAP in an integrated health system: a comparison of effects. Babcock HM et alChest 2004; 125: 2224-31 Reducing VAP rates through a staff education programme. Salahuddin N et al J Hosp Infect. 2004; 57 :223-7 Adherence to simple and effective measures reduces the incidence of VAP. Baxter AD et al Can J Anaesth. 2005; 52: 535-41

  19. VAP in Critical Care, RIE

  20. Conclusion • There is reasonable evidence from RCTs and their metanalyses to support the elements of the proposed ‘ Prevent VAP Care Bundle’ • Other groups have halved VAP rates through education programmes, reinforcing adoption of protocols to prevent VAP

More Related