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Published on: September 6, 2024
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Ventilation bundle compliance in two Australian intensive care units: An observational study
Auxillia Madhuvu1, Ruth Endacott2, Virginia Plummer3
1School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; Monash Health, Dandenong Hospital, 135 David Street, Dandenong, Victoria, Australia.
Summary
The ventilation bundle, a set of interventions for mechanically ventilated patients, showed increasing compliance over time in Australian ICUs. High APACHE III scores were associated with lower initial bundle adherence.
Area of Science:
- Critical Care Medicine
- Patient Safety
- Evidence-Based Practice
Background:
- The ventilation bundle is a proven strategy in adult ICUs to reduce harm in mechanically ventilated patients.
- It comprises five key interventions aimed at preventing complications like VAP, sepsis, and ARDS.
- These interventions include head of bed elevation, sedation interruption, DVT/peptic ulcer prophylaxis, and oral care.
Purpose of the Study:
- To evaluate the implementation and compliance of the ventilation bundle in two Australian intensive care units.
- To assess the feasibility of adhering to the bundle's components in a real-world clinical setting.
Main Methods:
- A 3-month prospective observational study was conducted in two ICUs.
- Patient records were reviewed on days 3, 4, and 5 of mechanical ventilation.
- A prevalidated checklist assessed compliance with ventilation bundle elements.
Main Results:
- 96 critically ill patients requiring mechanical ventilation >2 days were studied.
- Mean compliance with the ventilation bundle was 88.3%, increasing from 79.4% on day 3 to 96.7% on day 5.
- Higher APACHE III scores correlated with lower head-of-bed elevation compliance on days 3 and 4.
Conclusions:
- Ventilation bundle elements were utilized in Australian ICUs, demonstrating feasibility.
- Initial adherence on day 3 was lower for patients with higher APACHE III scores.
- Compliance rates significantly improved with continued mechanical ventilation.
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