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Published on: June 28, 2018
Effectiveness of a Ventilator Care Bundle to Prevent Ventilator-Associated Pneumonia at the PICU: A Systematic Review
Marjorie de Neef1, Leo Bakker2, Sandra Dijkstra3
1Intensive Care Unit, Department of Pediatrics, Amsterdam UMC - Emma Children's Hospital, Amsterdam, The Netherlands.
Insights
Implementing a ventilator care bundle significantly reduced ventilator-associated pneumonia in children. This intervention lowers infection rates in mechanically ventilated pediatric patients, improving outcomes.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
Background:
- Ventilator-associated pneumonia (VAP) is a common hospital-acquired infection in mechanically ventilated children.
- Effective strategies are needed to reduce VAP incidence in pediatric intensive care units (PICUs).
Purpose of the Study:
- To systematically review and meta-analyze the effectiveness of ventilator care bundles in reducing VAP rates in critically ill children.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (Embase, Medline, Web-of-Science, Cochrane, PubMed) from 1990 to 2017.
- Studies involving ventilator care bundles in PICUs with a primary objective to lower VAP rates were included.
- Meta-analysis was performed using a random-effects model to calculate the incidence risk ratio for VAP.
Main Results:
- Eleven studies were included in the meta-analysis.
- Implementation of ventilator care bundles led to a significant reduction in VAP incidence, with an incidence risk ratio of 0.45 (95% CI, 0.33-0.60).
- Median VAP incidence decreased from 9.8 to 4.6 episodes per 1,000 ventilator days.
Conclusions:
- Ventilator care bundles are effective in reducing the prevalence of VAP in mechanically ventilated children.
- These bundles represent a valuable quality improvement strategy for PICUs.
Objectives:
Ventilator-associated pneumonia is one of the most frequent hospital-acquired infections in mechanically ventilated children. We reviewed the literature on the effectiveness of ventilator care bundles in critically ill children.
Data Sources:
Embase, Medline OvidSP, Web-of-Science, Cochrane Library, and PubMed were searched from January 1990 until April 2017.
Study Selection:
Studies were included if they met the following criteria: 1) implementation of a ventilator care bundle in PICU setting; 2) quality improvement or multicomponent approach with the (primary) objective to lower the ventilator-associated pneumonia rate (expressed as ventilator-associated pneumonia episodes/1,000 ventilator days); and 3) made a comparison, for example, with or without ventilator care bundle, using an experimental randomized or nonrandomized study design, or an interrupted-times series. Exclusion criteria were (systematic) reviews, guidelines, descriptive studies, editorials, or poster publications.
Data Extraction:
The following data were collected from each study: design, setting, patient characteristics (if available), number of ventilator-associated pneumonia per 1,000 ventilator days, ventilator-associated pneumonia definitions used, elements of the ventilator care bundle, and implementation strategy. Ambiguities about data extraction were resolved after discussion and consulting a third reviewer (M.N., E.I.) when necessary. We quantitatively pooled the results of individual studies, where suitable. The primary outcome, reduction in ventilator-associated pneumonia per 1,000 ventilator days, was expressed as an incidence risk ratio with a 95% CI. All data for meta-analysis were pooled by using a DerSimonian and Laird random effect model.
Data Synthesis:
Eleven articles were included. The median ventilator-associated pneumonia incidence decreased from 9.8 (interquartile range, 5.8-18.5) per 1,000 ventilator days to 4.6 (interquartile range, 1.2-8.6) per 1,000 ventilator days after implementation of a ventilator care bundle. The meta-analysis showed that the implementation of a ventilator care bundle resulted in significantly reduced ventilator-associated pneumonia incidences (incidence risk ratio = 0.45; 95% CI, 0.33-0.60; p < 0.0001; I = 55%).
Conclusions:
Implementation of a ventilator-associated pneumonia bundle has the potential to reduce the prevalence of ventilator-associated pneumonia in mechanically ventilated children.
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