Archive for March, 2013

NTI Study Refutes Dogma of Ventilator Bundle Use to Prevent Ventilator Associated Pneumonia

Friday, March 1st, 2013

Ventilator associated pneumonia (VAP) is the most common serious infection that occurs in severely injured patients. For those who develop VAP, approximately 20% will not survive. While the mainstay of treatment of VAP remains antibiotic therapy, the emphasis from healthcare organizations has been on VAP prevention, and the Institute for Healthcare Improvement has advocated a “bundle” of care maneuvers to help prevent VAP, including stress ulcer prophylaxis, deep venous thrombosis prophylaxis, head-of-bed elevation, and daily sedation vacation with weaning assessment. Although the use of the ventilator bundle has been widely accepted, there is little evidence of its effectiveness. Furthermore, the Centers for Medicare and Medicaid Services have determined that VAP may be preventable with ventilator bundle use, and has threatened to reduce or eliminate payment to hospitals when a patient develops VAP.

The National Trauma Institute’s first completed research study analyzed the efficacy of the ventilator bundle in prevention of ventilator associated pneumonia in trauma patients who were in the Intensive care Unit (ICU) on a ventilator for at least two days. The research study, highlighted in the February issue of the Journal of Trauma and Acute Care Surgery, and first presented at the AAST Annual Meeting in Kauai, was led by Dr. Martin Croce at the University of Tennessee in Memphis, and enrolled over 600 patients at six Level 1 trauma centers nationally.

This study shows that VAP is more likely to occur in male patients, and those with severe chest injury, regardless of the ventilator bundle. Moreover, the study found that use of the ventilator bundle does not prevent or reduce the occurrence of VAP. Ultimately, critical analysis of dogma is important for patient care, and new, innovative means of ventilator associated pneumonia prevention are needed.