Claudia Pileggi1, Valentina Mascaro1, Aida Bianco1, Carmelo G A Nobile2,3, Maria Pavia1. 1. Department of Health Sciences, University of Catanzaro "Magna Gracia," Catanzaro, Italy. 2. Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy. 3. Department of Health Sciences, University of Catanzaro 'Magna Graecia', Catanzaro, Italy.
Abstract
OBJECTIVES: To assess the effectiveness of the ventilator bundle in the reduction of mortality in ICU patients. DATA SOURCES: PubMed, Scopus, Web of Science, Cochrane Library for studies published until June 2017. STUDY SELECTION: Included studies: randomized controlled trials or any kind of nonrandomized intervention studies, made reference to a ventilator bundle approach, assessed mortality in ICU-ventilated adult patients. DATA EXTRACTION: Items extracted: study characteristics, description of the bundle approach, number of patients in the comparison groups, hospital/ICU mortality, ventilator-associated pneumonia-related mortality, assessment of compliance to ventilator bundle and its score. DATA SYNTHESIS: Thirteen articles were included. The implementation of a ventilator bundle significantly reduced mortality (odds ratio, 0.90; 95% CI, 0.84-0.97), with a stronger effect with a restriction to studies that reported mortality in ventilator-associated pneumonia patients (odds ratio, 0.71; 95% CI, 0.52-0.97), to studies that provided active educational activities was analyzed (odds ratio, 0.88; 95% CI, 0.78-0.99), and when the role of care procedures within the bundle (odds ratio, 0.87; 95% CI, 0.77-0.99). No survival benefit was associated with compliance to ventilator bundles. However, these results may have been confounded by the differential implementation of evidence-based procedures at baseline, which showed improved survival in the study subgroup that did not report implementation of these procedures at baseline (odds ratio, 0.82; 95% CI, 0.70-0.96). CONCLUSIONS: Simple interventions in common clinical practice applied in a coordinated way as a part of a bundle care are effective in reducing mortality in ventilated ICU patients. More prospective controlled studies are needed to define the effect of ventilator bundles on survival outcomes.
OBJECTIVES: To assess the effectiveness of the ventilator bundle in the reduction of mortality in ICU patients. DATA SOURCES: PubMed, Scopus, Web of Science, Cochrane Library for studies published until June 2017. STUDY SELECTION: Included studies: randomized controlled trials or any kind of nonrandomized intervention studies, made reference to a ventilator bundle approach, assessed mortality in ICU-ventilated adult patients. DATA EXTRACTION: Items extracted: study characteristics, description of the bundle approach, number of patients in the comparison groups, hospital/ICU mortality, ventilator-associated pneumonia-related mortality, assessment of compliance to ventilator bundle and its score. DATA SYNTHESIS: Thirteen articles were included. The implementation of a ventilator bundle significantly reduced mortality (odds ratio, 0.90; 95% CI, 0.84-0.97), with a stronger effect with a restriction to studies that reported mortality in ventilator-associated pneumoniapatients (odds ratio, 0.71; 95% CI, 0.52-0.97), to studies that provided active educational activities was analyzed (odds ratio, 0.88; 95% CI, 0.78-0.99), and when the role of care procedures within the bundle (odds ratio, 0.87; 95% CI, 0.77-0.99). No survival benefit was associated with compliance to ventilator bundles. However, these results may have been confounded by the differential implementation of evidence-based procedures at baseline, which showed improved survival in the study subgroup that did not report implementation of these procedures at baseline (odds ratio, 0.82; 95% CI, 0.70-0.96). CONCLUSIONS: Simple interventions in common clinical practice applied in a coordinated way as a part of a bundle care are effective in reducing mortality in ventilated ICU patients. More prospective controlled studies are needed to define the effect of ventilator bundles on survival outcomes.
Authors: Brenda T Pun; Michele C Balas; Mary Ann Barnes-Daly; Jennifer L Thompson; J Matthew Aldrich; Juliana Barr; Diane Byrum; Shannon S Carson; John W Devlin; Heidi J Engel; Cheryl L Esbrook; Ken D Hargett; Lori Harmon; Christina Hielsberg; James C Jackson; Tamra L Kelly; Vishakha Kumar; Lawson Millner; Alexandra Morse; Christiane S Perme; Patricia J Posa; Kathleen A Puntillo; William D Schweickert; Joanna L Stollings; Alai Tan; Lucy D'Agostino McGowan; E Wesley Ely Journal: Crit Care Med Date: 2019-01 Impact factor: 7.598
Authors: Walter Zingg; Aliki Metsini; Carlo Balmelli; Dionysios Neofytos; Michael Behnke; Céline Gardiol; Andreas Widmer; Didier Pittet Journal: Euro Surveill Date: 2019-08
Authors: Brant M Wagener; Naseem Anjum; Sarah C Christiaans; Morgan E Banks; Jordan C Parker; Adam T Threet; Rashidra R Walker; Kayla D Isbell; Stephen A Moser; Troy Stevens; Mikhail F Alexeyev; Jonathon P Audia; Wito Richter; Kierra S Hardy; Lina Abou Saleh; Charity Morgan; Jean-François Pittet Journal: Toxins (Basel) Date: 2020-06-04 Impact factor: 4.546