Compliance with VAP bundle implementation and its effectiveness on surgical and medical sub-population in adult ICU

Despite broad implementation of a bundled strategy aimed at preventing VAP Bundle-ICU; ventilator-associated adverse events in many hospitals, the ability of the bundle to prevent VAP has Compliance not been definitively established with high-quality studies. To implement VAP bundle as a performance improvement project in adult ICU and follow up the compliance rate over the 12 month study period as well as the effectiveness on surgical and medical subgroups. VAP Bundle Program was implemented in adult ICU, data were collected and analyzed for ventilated-associated pneumonia [VAP], and compared before and after intervention. Our bundle components were head of bed elevation greater than 30°, daily sedation break, assessment for extubation, peptic ulcer prophylaxis and deep vein thrombosis prophylaxis. The results clearly show the difference between pre and post-intervention period and lower VAP rate after application of VAP bundle. The total VAP bundle compliance rate steadily increased during the period of implementation. We documented a significant reduction of mean ICU LOS [from 15.4 +/- 5.2 to 10.8 +/- 4.9 days] and duration of mechanical ventilation [from 12.8 +/- 4.9 to 8.5 +/- 4.3 days] for patients with VAP bundle compliance at the end of the study. There was a significant improvement in the outcome of surgical patients who were studied after VAP bundle initiation reflecting a decreased mortality rate. Our study highlights that adherence with the VAP-bundle approach in our ICU decreases the incidence of VAP, more rapid ventilator weaning, fewer ICU days, and shorter hospitalizations and it has also a great impact on patient outcomes. Our study looked into surgical subpopulation as getting more benefit by initiation of the VAP bundle in reducing the length of stay. Thus it results in a decrease in the burden of the health care costs and the ICU resources

Role of non invasive ventilation in limiting re-intubation after planned extubation

Introduction: In critically ill adult patients, particularly patients with chronic obstructive pulmonary disease [COPD], early use of non invasive ventilation [NIV] after weaning may be associated with the decrease of mortality. The effect of this benefit is not so clear in ICU mixed populations

Aim of the work: Compare the efficacy of NIV to Oxygen Mask in preventing re-intubation if NIV was used immediately following planned extubation in patients with respiratory failure of various etiologies requiring mechanical ventilation for more than 48 h

Patients and methods: One hundred and twenty patients were randomly enrolled in this study. Sixty patients assigned to the noninvasive-ventilation group received ventilation through a full facial mask from a BIPAP ventilator located in the intensive care unit immediately after extubation [group I] while the other sixty patients put on oxygen mask group will be [group II] and act as control group

Results: There was no significant difference regarding sex distribution and smoking pattern, also APACHE II score, hemodynamic and electrolytes which might have a role in respiratory failure showed no statistically significant differences between both studied groups .The mean duration of mechanical ventilation was lower in group I than in group II, 6.2 +/- 1.6 versus 7.1 +/- 1.8 days, respectively, however this difference was not significant [p-0.09]. The overall re-intubation rate [15%] was significantly lower in group I compared to group II which was 25% and p-value 0.04. The re-intubation rate of COPD patients in group I was statistically lower than group II [p-0.019]. Hospital mortality rate showed a statistically significant difference between both groups, with four deaths during ICU stay in the NIV group [6.6%], while there were 10 deaths [16.6%] in the Oxygen Mask group [p < 0.035]

Conclusion: Early application of non invasive ventilation could be effective in limiting the need for re-intubation and decrease mortality in electively extubated patients with various aetiologies of respiratory failure. Also selected patients with respiratory failure [COPD] may get more benefit from this therapy