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Ventilator Bundles PDF
Ventilator Bundles PDF
Irene Arago
Outubro 2008
What is a bundle?
A grouping of best practices with respect to a disease
Ventilator bundle
.is a package of evidence-based
interventions that, when
implemented together for all patients
on mechanical ventilation, has
resulted in dramatic reductions in the
incidence of ventilator-associated
pneumonia.
Bundle Considerations
Supine:
34%
(p=0.003)
Confirmed VAP:
5%
(p=0.018)
Drakulovic MB. Lancet 1999; 354: 1851-1858
23%
Duration of ventilation:
4.9 days vs. 7.3 days (p=0.004)
Crit
Goal
Level of Reliability
(compliance with all elements):
Reduction in
VAP Rate:
Unchanged
22%
<95% compliance
40%
>95% compliance
61%
Reducing VAP
Santo Antonio Hospital Campaign
PQIP
data
Reducing VAP
Santo Antonio Hospital Campaign
Reducing VAP
Santo Antonio Hospital Campaign
Reducing VAP
Santo Antonio Hospital Campaign
Reducing VAP
Santo Antonio Hospital Campaign
1.
2.
3.
4.
Reducing VAP
Santo Antonio Hospital Campaign
DATA
N CAMA INICIAIS
do DOENTE
ELEVAO DA
CABECEIRA
DA CAMA
30/45
INTERRUPO DA
SEDAO
SIM
NO
SEM
SEDA
O
PROFILAXIA DA
LCERA DE
STRESS
PROFILAXIA
TROMBOSE
VENOSA
PROFUNDA
DIA
10
ELEVAO DA CABECEIRA DA
CAMA A 30/45
INTERRUPO DA SEDAO
PROFILAXIA DA LCERA DE
STRESS
SEM SEDAO
Five elements:
1. Elevation of the head of the bed to between 30
and 45 degrees
2.Daily awakening: sedation vacation
3.Daily assessment of readiness for weaning
4. DVT prophylaxis (unless contraindicated)
5. Stress bleeding prophylaxis
IHI 2007
97,46%
97,22%
98,94%
100,00%
100,00%
94,00%
90,00%
85,00%
80,00%
75,00%
br
o
m
ez
e
D
ov
e
m
br
o
ub
ro
O
ut
te
m
br
o
Se
to
go
s
A
Ju
lh
o
70,00%
55,00
50,00
60,00
55,00
45,00
50,00
50,00
40,00
40,00
34,65
30,00
33,33
19,14
20,00
PAV 2007
31,09
10,00
30,30
21,05
PAV 2006
0,00
PAV 2006
PAV 2007
12,6
5,7
p<0.001
8,8
4,7
p<0,001
Surg
45,1
27,9
Med
22,4
11,6
Babcock et al
Chest 2004
Lai et al
Infec Control Hosp Epidemiol 2003