RATIONALE: Mechanical ventilation is associated with morbidity in patients with brain injury. OBJECTIVES: This study aims to assess the effectiveness of an extubation readiness bundle to decrease ventilator time in patients with brain injury. METHODS: Before-after design in two intensive care units (ICUs) in one university hospital. Brain-injured patients ventilated more than 24 hours were evaluated during two phases (a 3-yr control phase followed by a 22-mo intervention phase). Bundle components were protective ventilation, early enteral nutrition, standardization of antibiotherapy for hospital-acquired pneumonia, and systematic approach to extubation. The primary endpoint was the duration of mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: A total of 299 and 200 patients, respectively, were analyzed in the control and the intervention phases of this before-after study. The intervention phase was associated with lower tidal volume (P < 0.01), higher positive end-expiratory pressure (P < 0.01), and higher enteral intake in the first 7 days (P = 0.01). The duration of mechanical ventilation was 14.9 ± 11.7 days in the control phase and 12.6 ± 10.3 days in the intervention phase (P = 0.02). The hazard ratio for extubation was 1.28 (95% confidence interval [CI], 1.04-1.57; P = 0.02) in the intervention phase. Adjusted hazard ratio was 1.40 (95% CI, 1.12-1.76; P < 0.01) in multivariate analysis and 1.34 (95% CI, 1.03-1.74; P = 0.02) in propensity score-adjusted analysis. ICU-free days at Day 90 increased from 50 ± 33 in the control phase to 57 ± 29 in the intervention phase (P < 0.01). Mortality at Day 90 was 28.4% in the control phase and 23.5% in the intervention phase (P = 0.22). CONCLUSIONS: The implementation of an evidence-based extubation readiness bundle was associated with a reduction in the duration of ventilation in patients with brain injury.
RATIONALE: Mechanical ventilation is associated with morbidity in patients with brain injury. OBJECTIVES: This study aims to assess the effectiveness of an extubation readiness bundle to decrease ventilator time in patients with brain injury. METHODS: Before-after design in two intensive care units (ICUs) in one university hospital. Brain-injured patients ventilated more than 24 hours were evaluated during two phases (a 3-yr control phase followed by a 22-mo intervention phase). Bundle components were protective ventilation, early enteral nutrition, standardization of antibiotherapy for hospital-acquired pneumonia, and systematic approach to extubation. The primary endpoint was the duration of mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: A total of 299 and 200 patients, respectively, were analyzed in the control and the intervention phases of this before-after study. The intervention phase was associated with lower tidal volume (P < 0.01), higher positive end-expiratory pressure (P < 0.01), and higher enteral intake in the first 7 days (P = 0.01). The duration of mechanical ventilation was 14.9 ± 11.7 days in the control phase and 12.6 ± 10.3 days in the intervention phase (P = 0.02). The hazard ratio for extubation was 1.28 (95% confidence interval [CI], 1.04-1.57; P = 0.02) in the intervention phase. Adjusted hazard ratio was 1.40 (95% CI, 1.12-1.76; P < 0.01) in multivariate analysis and 1.34 (95% CI, 1.03-1.74; P = 0.02) in propensity score-adjusted analysis. ICU-free days at Day 90 increased from 50 ± 33 in the control phase to 57 ± 29 in the intervention phase (P < 0.01). Mortality at Day 90 was 28.4% in the control phase and 23.5% in the intervention phase (P = 0.22). CONCLUSIONS: The implementation of an evidence-based extubation readiness bundle was associated with a reduction in the duration of ventilation in patients with brain injury.
Authors: Karim Asehnoune; Zsolt Balogh; Giuseppe Citerio; Andre Cap; Timothy Billiar; Nino Stocchetti; Mitchell J Cohen; Paolo Pelosi; Nicola Curry; Christine Gaarder; Russell Gruen; John Holcomb; Beverley J Hunt; Nicole P Juffermans; Mark Maegele; Mark Midwinter; Frederick A Moore; Michael O'Dwyer; Jean-François Pittet; Herbert Schöchl; Martin Schreiber; Philip C Spinella; Simon Stanworth; Robert Winfield; Karim Brohi Journal: Intensive Care Med Date: 2017-07-29 Impact factor: 17.440
Authors: Karim Asehnoune; Ségolène Mrozek; Pierre François Perrigault; Philippe Seguin; Claire Dahyot-Fizelier; Sigismond Lasocki; Anne Pujol; Mathieu Martin; Russel Chabanne; Laurent Muller; Jean Luc Hanouz; Emmanuelle Hammad; Bertrand Rozec; Thomas Kerforne; Carole Ichai; Raphael Cinotti; Thomas Geeraerts; Djillali Elaroussi; Paolo Pelosi; Samir Jaber; Marie Dalichampt; Fanny Feuillet; Véronique Sebille; Antoine Roquilly Journal: Intensive Care Med Date: 2017-03-18 Impact factor: 17.440
Authors: R Cinotti; A Dordonnat-Moynard; F Feuillet; A Roquilly; N Rondeau; D Lepelletier; J Caillon; N Asseray; Y Blanloeil; B Rozec; K Asehnoune Journal: Eur J Clin Microbiol Infect Dis Date: 2013-12-10 Impact factor: 3.267