Ventilator-associated Pneumonia
Conditions
Keywords
Ventilator-associated pneumonia
Brief summary
Ventilator-associated pneumonia (VAP) is a common complication of mechanical ventilation associated with significant morbidity, including prolongation of mechanical ventilation and increased ICU and hospital length-of-stay. Numerous strategies have been proposed to decrease the occurrence of VAP among ventilated patients. Most notably, optimizing the use of daily sedative interruptions and daily spontaneous breathing trials can improve sedative management, decrease ventilator time, improve outcomes for mechanically ventilated patients,and possibly decrease VAP.Combining daily sedative interruption with daily spontaneous breathing trials confers additive improvement in ventilator days, intensive care days, and possibly mortality compared to daily spontaneous breathing trials alone. The primary aim of this study is to determine the impact of an opt-out protocol for paired daily sedative interruptions and spontaneous breathing trials on VAP rates using a new streamlined VAP definition. The investigators will evaluate the responsiveness of CDC's proposed new surveillance definitions for ventilator-associated events to this quality improvement initiative. The study will be nested within the Epicenters Streamlined versus Conventional VAP Surveillance Study. Nine of the 18 hospitals in the larger study will be participating in this intervention arm.
Interventions
PROCEDUREDaily SAT & SBT
Nurse and/or respiratory therapist led daily awakenings from sedation (spontaneous awakening trial, or SAT) and daily performance of a spontaneous breathing trial (SBT) among mechanically ventilated, critically ill patients in participating ICUs.
Sponsors
Centers for Disease Control and Prevention
Washington University School of Medicine
Rush University Medical Center
University of Pennsylvania
Duke University
North Shore Medical Center
Harvard Pilgrim Health Care
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* all patients in participating units on mechanical ventilation for at least one calendar day beting treated with continuous sedatives or standing orders for sedatives. Patients receiving mechanical ventilation through either an endotracheal or tracheostomy tube will be eligible.
Exclusion criteria
* moribund status or plans for withdrawal of life support
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in VAC rate. | 12 months | A new definition for VAP is the primary focus of this study. This new definition (referred to as streamlined VAP or sVAP) is under consideration by the CDC as a potential replacement for the current NHSN VAP definition and, as such, will be closely evaluated to determine if it can reflect meaningful changes in patient care. Thus, we will assess the change in monthly sVAP rates from study start to study end using an interrupted time series analysis. Note that CDC released new surveillance definitions for ventilator-associated events in late 2012. Given that CDC definitions are the defacto surveillance standard, we switched the primary study outcome from sVAP to ventilator-associated conditions (VAC). All data elements required to assess for VAC were included in this study from the outset hence we did not have to collect any additional historical data in order to apply CDC's VAC definition. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| ICU-specific outcomes | 12-months | * NHSN VAP rate * Mechanical ventilation days per patient * Ventilator-free days assessed over 28 days post-intubation * ICU length of stay per patient * Average antibiotic days * Rates of extubation and reintubation within 48 hours |
| Hospital-specific outcomes | 12-months | * Hospital length of stay * Hospital mortality |
| Patient-specific outcomes | 12-months | * Mean ventilator days * Mean ICU days * Mean hospital days The above results will also be assessed separately for patients who received opt-out protocol care versus those who did not. |
Countries
United States
Outcome results
None listed