”Bundle” Practices and Ventilator Associated Events: Not Enough Abbreviated Title: The VAE Bundle
Objective: Ventilator associated events (VAE”s) are iatrogenic events correlated with length of stay, costs and mortality.Current ventilator bundle practices are targeted at the older definition of ventilator associated pneumonia, and have not been systematically evaluated for their impact on VAE.Design: Retrospective cohort study Setting: Tertiary medical center between January 2012 and August 2014 Patients or Other Participants: All adult patients ventilated for at least 24 hours at our institution.Interventions: Univariate analysis was conducted for compliance with each element,looking a VAEs occurring within a 2 day window of failure to meet any ventilator bundle element.Cox proportional hazard models were used to assess the effect of stress ulcer prophylaxis, deep vein thrombosis (DVT) prophylaxis, oral cares, and sedation breaks on VAE.Models were adjusted for gender, age, and Acute Physiology and Chronic Health Evaluation (APACHE) Ⅲ scores.Results: Our cohort comprised 2,660 patients with 16,858 ventilator days and 77 VAEs.Adjusting for APACHE score and gender, only oral cares were associated with a reduction in the risk ofVAE (HR 0.44;95% CI, 0.26-0.77).The DVT prophylaxis and sedation breaks did not show any significant impact.Stress ulcer prophylaxis trended towards an increased risk ofVAE (HR 1.59;95% CI, 1.00-2.56).Conclusion: Although we are limited by a low baseline rate of VAE, existing ventilator bundle practices do not appear to target VAE well.Oral cares is clearly important, but the impact of DVT prophylaxis, sedation breaks, and especially stress ulcer prophylaxis are questionable at best.
Ventilator Associated pneumonia Ventilator associated event bundle,VAP,VAE
Haitao Lan John C.O”Horo Charat Thongprayoon Louis Schenck Adil Ahmed Mikhail Dziadzko Ognjen Gajic Priya Sampathkumar
国内会议
世界中联医院感染管理专业委员会成立大会暨首届中医院感染管理国际论坛
北京
英文
25-33
2016-07-07（万方平台首次上网日期，不代表论文的发表时间）