TY - JOUR
T1 - The preventability of ventilator-associated events
T2 - The CDC Prevention Epicenters Wake Up and Breathe Collaborative
AU - CDC Prevention Epicenters
AU - Klompas, Michael
AU - Anderson, Deverick
AU - Trick, William
AU - Babcock, Hilary
AU - Kerlin, Meeta Prasad
AU - Li, Lingling
AU - Sinkowitz-Cochran, Ronda
AU - Ely, E. Wesley
AU - Jernigan, John
AU - Magill, Shelley
AU - Lyles, Rosie
AU - O'Neil, Caroline
AU - Kitch, Barrett T.
AU - Arrington, Ellen
AU - Balas, Michele C.
AU - Kleinman, Ken
AU - Bruce, Christina
AU - Lankiewicz, Julie
AU - Murphy, Michael V.
AU - Cox, Christopher E.
AU - Lautenbach, Ebbing
AU - Sexton, Daniel
AU - Fraser, Victoria
AU - Weinstein, Robert A.
AU - Platt, Richard
N1 - Publisher Copyright:
Copyright © 2015 by the American Thoracic Society.
PY - 2015/2/1
Y1 - 2015/2/1
N2 - Rationale: The CDC introduced ventilator-associated event (VAE) definitions in January 2013. Little is known about VAE prevention. We hypothesized that daily, coordinated spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs) might prevent VAEs. Objectives: To assess the preventability of VAEs. Methods: We nested a multicenter quality improvement collaborative within a prospective study of VAE surveillance among 20 intensive care units between November 2011 and May 2013. Twelve units joined the collaborative and implemented an opt-out protocol for nurses and respiratory therapists to perform paired daily SATs and SBTs. The remaining eight units conducted surveillance alone. We measured temporal trends in VAEs using generalized mixed effects regression models adjusted for patient-level unit, age, sex, reason for intubation, Sequential Organ Failure Assessment score, and comorbidity index. Measurements and Main Results: We tracked 5,164 consecutive episodes of mechanical ventilation: 3,425 in collaborative units and 1,739 in surveillance-only units. Within collaborative units, significant increases in SATs, SBTs, and percentage of SBTs performed without sedation were mirrored by significant decreases in duration of mechanical ventilation and hospital length-of-stay. There was no change in VAE risk per ventilator day but significant decreases in VAE risk per episode of mechanical ventilation (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.42-0.97) and infection-related ventilator-associated complications (OR, 0.35; 95% CI, 0.17-0.71) but not pneumonias (OR, 0.51; 95% CI, 0.19-1.3). Within surveillance-only units, there were no significant changes in SAT, SBT, or VAE rates. Conclusions: Enhanced performance of paired, daily SATs and SBTs is associated with lower VAE rates. Clinical trial registered with www.clinicaltrials.gov (NCT 01583413).
AB - Rationale: The CDC introduced ventilator-associated event (VAE) definitions in January 2013. Little is known about VAE prevention. We hypothesized that daily, coordinated spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs) might prevent VAEs. Objectives: To assess the preventability of VAEs. Methods: We nested a multicenter quality improvement collaborative within a prospective study of VAE surveillance among 20 intensive care units between November 2011 and May 2013. Twelve units joined the collaborative and implemented an opt-out protocol for nurses and respiratory therapists to perform paired daily SATs and SBTs. The remaining eight units conducted surveillance alone. We measured temporal trends in VAEs using generalized mixed effects regression models adjusted for patient-level unit, age, sex, reason for intubation, Sequential Organ Failure Assessment score, and comorbidity index. Measurements and Main Results: We tracked 5,164 consecutive episodes of mechanical ventilation: 3,425 in collaborative units and 1,739 in surveillance-only units. Within collaborative units, significant increases in SATs, SBTs, and percentage of SBTs performed without sedation were mirrored by significant decreases in duration of mechanical ventilation and hospital length-of-stay. There was no change in VAE risk per ventilator day but significant decreases in VAE risk per episode of mechanical ventilation (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.42-0.97) and infection-related ventilator-associated complications (OR, 0.35; 95% CI, 0.17-0.71) but not pneumonias (OR, 0.51; 95% CI, 0.19-1.3). Within surveillance-only units, there were no significant changes in SAT, SBT, or VAE rates. Conclusions: Enhanced performance of paired, daily SATs and SBTs is associated with lower VAE rates. Clinical trial registered with www.clinicaltrials.gov (NCT 01583413).
KW - Quality improvement
KW - Surveillance
KW - Ventilator-associated events
UR - http://www.scopus.com/inward/record.url?scp=84922326922&partnerID=8YFLogxK
U2 - 10.1164/rccm.201407-1394OC
DO - 10.1164/rccm.201407-1394OC
M3 - Article
C2 - 25369558
AN - SCOPUS:84922326922
SN - 1073-449X
VL - 191
SP - 292
EP - 301
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 3
ER -