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[Clinical investigation on the compliance and the validity of ventilator bundle].

OBJECTIVE
To investigate the compliance of ventilator bundle implementation and its preventive effect on ventilator associated pneumonia (VAP).


METHODS
A before and after design was used in this single center study. Patients aged from 18 to 80 years, with mechanical ventilation (MV) duration over 48 hours were recruited during 1 year before (control group) and 2 years after bundle implementation (intervention group). Measurements included the rate of successful ventilator bundle implementation in intervention group, incidence of VAP, duration of MV and mortality within 28 days in both groups.


RESULTS
A total number of 237 patients, including 71 patients in control arm and 166 patients in intervention arm, were recruited in this study. There was no statistical significance in ratio of sex, mean age, category of diseases or mean acute physiology and chronic health evaluation II (APACHE II) score between two groups (all P>0.05). Significant changes were not found in MV duration [(5.9+/-5.6) days vs. (5.2+/-6.1) days], incidence of VAP (21.1% vs. 20.5%) and mortality within 28 days (16.9% vs. 19.8%) between control and intervention group as well. In intervention group, 57 of 166 (34.3%) patients were successfully implemented all of four ventilator bundle items. The successful rate of ventilator bundle implementation were 62.5% (35/56), 22.1% (21/95) and 6.7% (1/15) in patients received MV duration < or =3 days, 4-7 days and >7 days respectively. Among the four items of the bundle, head of bed elevation > or =30 degree angle had the lowest successful rate [43.4% (72/166)]. But it was much better in the implementation of daily wake-up plus weaning, prevention of peptic ulcer and prevention of deep vein thrombosis formation [92.2% (153/166), 88.0% (146/166) and 83.1% (138/166) respectively].


CONCLUSION
The poor compliance of ventilator bundle is an important factor in impacting the efficacy of ventilator bundle.