The ventilator care bundle and its impact on ventilator‐associated pneumonia: a review of the evidence

Abstract

Aims and objectives:The aim of this review was to critically analyse recent research that has investigated ventilator care bundle (VCB) use, with the objective of analysing its impact on ventilator-associated pneumonia (VAP) outcomes. Background: The VCB is a group of four evidence-based procedures, which when clustered together and implemented as an 'all or nothing' strategy, may result in substantial clinical outcome improvement. VAP is a nosocomial lung infection associated with endotracheal tube use in ventilated patients. Since the VCB was introduced there have been several studies that have reported significant VAP rate reductions. Search strategy: A comprehensive search for research, published between 2004 and 2009, was conducted using Medline and PubMed. Key words were used to identify English language studies reporting VCB implementation within adult intensive care units (ICU) and associated clinical outcomes. Studies that implemented bundle variations that did not include all four elements were excluded. Conclusions: Because of the limitations of the observational designs used in the studies retrieved, a definitive causal relationship between VCB use and VAP reduction cannot be stated. However, the evidence to date is strongly indicative of a positive association. Several studies reported the use of additional VCB elements. In these cases it is difficult to establish which elements are related to the measured outcomes. Further research is recommended to establish baseline outcome measures using the four-element VCB, before adding further processes singly, as well as research investigating the effect of audit and feedback on VCB compliance and its effect on clinical outcomes. Relevance to clinical practice: A reduction in VAP is associated with VCB use. The evidence to date, whilst not at the highest experimental level, is at the highest ethically permissible level. In the absence of contradictory research, the current evidence suggests that use of the VCB represents best practice for all eligible adult ventilated patients in ICU.

Dedicated Multidisciplinary Ventilator Bundle Team and Compliance with Sedation Vacation

“…[6][7][8][9][10] As expected, cessation of sustained efforts to monitor compliance are associated with increased rates of VAP. 11 Further, institutions are encouraged to customize the ventilator bundle to their institutional culture in order to maximize effectiveness.…”

“…However, our intention in this study was not to address the effect of the ventilator bundle on VAP rates, as this has been evaluated previously. [6][7][8][9][10] Rather, we hoped to shed light on best practices for the assessment of compliance with the ventilator bundle. We chose to assess only the components of the bundle that were recorded in this database.…”

Management of Respiratory Failure

“…10 A cuffed endotracheal tube is not a guarantee against aspiration, which can still occur around an inflated cuff. [31][32][33] Aspiration of gastric contents may predispose to the development of hospitalacquired pneumonia in patients receiving mechanical ventilation. There is evidence that this can be reduced by nursing all mechanically ventilated patients in a 30 • head-up position.…”

Bundle Method In Reducing Pneumonia Associated With Mechanical Ventilation In Newborns And Children: Integrative Review

“…Corroborating the findings, another study highlighted that the efficacy of oral cleaning with chlorhexidine in children admitted to the ICU is considered a moderate evidence when related to the reduction in the occurrence of PAV. Brushing teeth is considered a weak evidence [24][25][26].…”