Impact of a multidisciplinary checklist on the duration of invasive mechanical ventilation and length of ICU stay

Abstract

Objective: To assess the impact that implementing a checklist during daily multidisciplinary rounds has on the duration of invasive mechanical ventilation (IMV) and length of ICU stay. Methods: This was a non-randomized clinical trial in which the pre-intervention and post-intervention duration of IMV and length of ICU stay were evaluated in a total of 466 patients, including historical controls, treated in three ICUs of a hospital in the city of Caxias do Sul, Brazil. We evaluated 235 and 231 patients in the pre-intervention and post-intervention periods, respectively. The following variables were studied: age; gender; cause of hospitalization; diagnosis on admission; comorbidities; the Simplified Acute Physiology Score 3; the Sequential Organ Failure Assessment score; days in the ICU; days on IMV; reintubation; readmission; in-hospital mortality; and ICU mortality. Results: After the implementation of the checklist, the median (interquartile range) for days in the ICU and for days on IMV decreased from 8 (4-17) to 5 (3-11) and from 5 (1-12) to 2 (< 1-7), respectively, and the differences were significant (p ≤ 0.001 for both). Conclusions: The implementation of the checklist during daily multidisciplinary rounds was associated with a reduction in the duration of IMV and length of ICU stay among the patients in our sample.

Hospital characteristics associated with COVID-19 mortality: data from the multicenter cohort Brazilian Registry

“…Some pre-pandemic studies, including one in Brazilian ICUs, found an association between the implementation of clinical protocols in the ICU and mortality [ 10 , 11 , 45 ]. In the present study, even though the number of protocols implemented in ICUs was included in the multivariate analysis, this variable did not remain in the final model.…”

“…As this study showed that the professional experience of the medical team was associated with lower mortality, investing in training and senior supervision of the medical team could improve outcomes in emergency situations, such as the COVID-19 pandemic. Different training and organizational strategies could be employed, such as supervision from senior staff, the use of simulators for training, and implementing tele-strategies in the ICU, and the use of daily checklists and multidisciplinary rounds [ 42 , 45 , 47 , 48 ].…”

Improving enteral nutrition delivery in the critically ill trauma and surgical population

“…Although not considered a component of the EP, while implementing the new protocol, our ICU began to use morning multiprofessional rounds prior to traditional system‐based ICU rounds. Benefits of a multiprofessional rounding process include enhanced mobility and reductions in ventilator days and ICU length of stay 15,16 . During our institution's multiprofessional rounds, the percentage of EN delivery goal is presented daily.…”

“…Benefits of a multiprofessional rounding process include enhanced mobility and reductions in ventilator days and ICU length of stay. 15,16 During our institution's multiprofessional rounds, the percentage of EN delivery goal is presented daily. Additionally, any 24-h events that interrupted delivery of EN were discussed during rounds, and these data were captured by the clinical dietitian.…”

Estratégias educativas para prevenção de pneumonia associada à ventilação mecânica em terapia intensiva: revisão integrativa

“…Percebe-se que múltiplos métodos de prevenção têm mostrado maior eficácia na prevenção de PAVM. A manutenção de decúbito elevado, extubação precoce, higiene oral, higiene de mãos, antibioticoterapia adequadas além de conhecimento sobre identificação de PAVM, os padrões de ventilação e manuseio do ventilador mecânico são alguns métodos para promoção, controle e prevenção de danos aos pacientes que devem ser associadas a medidas educativas (Alecrim et al, 2019;Barcellos & Chatkin, 2020;Morris et al, 2011).…”