Improving Ventilator Care Quality Through a Structured Ventilator Pathway: A Retrospective Pre-Post Quality...

Introduction Introduction Mechanical ventilation (MV) is a lifesaving intervention for critically ill patients; however, it is associated with increased risk of developing mechanical, pulmonary, and sepsis-related complications, as well as high mortality. The ventilator-associated pneumonia (VAP) bundle, though widely used, is limited by its subjectivity and poor sensitivity and specificity. The National Healthcare Safety Network introduced ventilator-associated events (VAE) surveillance in 2013, subsequently modified by the Centers for Disease Control and Prevention (CDC), with an updated VAE classification: ventilator-associated condition (VAC), infection-related ventilator-associated complication (IVAC), and possible ventilator-associated pneumonia (PVAP). This study aimed to assess VAE incidence at a tertiary care center and evaluate the impact of implementing a ventilator pathway (an educational and interventional initiative) on patient outcomes and VAE rates. Methods This retrospective study included patients receiving MV for >48 hours. A pre-implementation survey, conducted among intensive care unit (ICU) staff (n=140) regarding components of ventilator care, along with an audit of VAP bundle awareness/compliance, identified deficiencies in ventilator care practices, lack of monitoring, and gaps in knowledge. In response, a ventilator pathway incorporating evidence-based care components was developed, followed by staff training and implementation. VAE was identified using CDC-defined criteria. Results The study population was divided into two groups: pre-implementation (n=137) and post-implementation (n=431). Baseline characteristics and disease severity were comparable between the groups. Hospital length of stay decreased from 19 to 16 days (p=0.01), with no significant differences in ICU length of stay or duration of MV. Survival was higher in the post-implementation group (63.1% (272/431)) compared to that in the pre-implementation group (56.2% (77/137)), although the difference was not statistically significant. VAE incidence decreased significantly from 28.46% (39/137) to 3.71% (16/431) (p<0.001), corresponding to an 87% relative risk reduction. Similar significant decreases were observed in the incidences of VAC (15/137 (10.94%) vs. 11/431 (2.55%); p<0.001), IVAC (7/137 (5.11%) vs. 6/431 (1.39%); p<0.05), and PVAP post-implementation of the pathway (10/137 (7.29%) vs. 1/431 (0.23%); p<0.001). Total infection rate decreased from 12.40% (17/137) to 1.62% (7/431) (p<0.001) after pathway implementation. Conclusion Implementation of a structured ventilator pathway, combined with targeted education and adherence monitoring, was associated with reduced VAE incidence and infection rates and improved patient outcomes. These findings indicate improved infection control and care standardization after pathway implementation. These improvements highlight the effectiveness of clinical pathways as sustainable quality improvement tools.