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Impact of a national collaborative project to improve the care of mechanically ventilated patients.

ABSTRACT: This prospective quasi-experimental study from the NASAM (National Approach to Standardize and Improve Mechanical Ventilation) collaborative assessed the impact of evidence-based practices including subglottic suctioning, daily assessment for spontaneous awakening trial (SAT), spontaneous breathing trial (SBT), head of bed elevation, and avoidance of neuromuscular blockers unless otherwise indicated. The study outcomes included VAE (primary) and intensive care unit (ICU) mortality. Changes in daily care process measures and outcomes were evaluated using repeated measures mixed modeling. The results were reported as incident rate ratio (IRR) for each additional month with 95% confidence interval (CI). A comprehensive program that included education on evidence-based practices for optimal care of mechanically ventilated patients with real-time benchmarking of daily care process measures to drive improvement in forty-two ICUs from 26 hospitals in Saudi Arabia (>27,000 days of observation). Compliance with subglottic suctioning, SAT and SBT increased monthly during the project by 3.5%, 2.1% and 1.9%, respectively (IRR 1.035, 95%CI 1.007-1.064, p = 0.0148; 1.021, 95% CI 1.010-1.032, p = 0.0003; and 1.019, 95%CI 1.009-1.029, p = 0.0001, respectively). The use of neuromuscular blockers decreased monthly by 2.5% (IRR 0.975, 95%CI 0.953-0.998, p = 0.0341). The compliance with head of bed elevation was high at baseline and did not change over time. Based on data for 83153 ventilator days, VAE rate was 15.2/1000 ventilator day (95%CI 12.6-18.1) at baseline and did not change during the project (IRR 1.019, 95%CI 0.985-1.053, p = 0.2812). Based on data for 8523 patients; the mortality was 30.4% (95%CI 27.4-33.6) at baseline, and decreased monthly during the project by 1.6% (IRR 0.984, 95%CI 0.973-0.996, p = 0.0067). A national quality improvement collaborative was associated with improvements in daily care processes. These changes were associated with a reduction in mortality but not VAEs. Registration The study is registered in clinicaltrials.gov (NCT03790150).

SUBMITTER: Arabi YM

PROVIDER: S-EPMC9886257 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

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Impact of a national collaborative project to improve the care of mechanically ventilated patients.

Arabi Yaseen M YM Al Aseri Zohair Z Alsaawi Abdulmohsen A Al Khathaami Ali M AM Al Qasim Eman E Alzahrani Abdullah A AA Al Qarni Mohammed M Abdukahil Sheryl Ann I SAI Al-Dorzi Hasan M HM Alattasi Abdulaleem A Mandourah Yasser Y Alaama Tareef Y TY Alabdulaali Mohammed K MK Alqahtani Abdulrahman A Shuaibi Ahmad A Al Qarni Ali A Alkatheri Mufareh M Al Hazme Raed H RH Vishwakarma Ramesh Kumar RK Aldibasi Omar O Alshahrani Mohammed Saeed MS Attia Ashraf A Alharthy Abdulrahman A Mady Ahmed A Abdelrahman Basheer Abdullah BA Mhawish Huda Ahmad HA Abdallah Hassan Ahmad HA Al-Hameed Fahad F Alghamdi Khalid K Alghamdi Adnan A Almekhlafi Ghaleb A GA Qasim Saleh Abdorabo Haider SAH Al Haji Hussain Ali HA Al Mutairi Mohammed M Tashkandi Nabiha N Alabbasi Shatha Othman SO Al Shehri Tariq T Moftah Emad E Kalantan Basim B Matroud Amal A Naidu Brintha B Al Zayer Salha S Burrows Victoria V Said Zayneb Z Soomro Naseer Ahmed NA Yousef Moawea Hesham MH Fattouh Ayman Abdulmonem AA Tahoon Manar Aboelkhair MA Muhammad Majdi M Alruwili Afifah Muslim AM Al Hanafi Hossam Ahmed HA Dandekar Pramodini B PB Ibrahim Kamel K AlHomsi Mwafaq M Al Harbi Asma Rayan AR Saleem Adel A Masih Ejaz E Al Rashidi Nowayer Monawer NM Amanatullah Aslam Khan AK Al Mubarak Jaffar J Al Radwan Amro Ali Abduljalil AAA Al Hassan Ali A Al Muoalad Sadiyah S Alzahrani Ammar Abdullah AA Chalabi Jamal J Qureshi Ahmad A Al Ansari Maryam M Sallam Hend H Elhazmi Alyaa A Alkhaldi Fawziah F Malibary Abdulrauf A Ababtain Abdullah A Latif Asad A Berenholtz Sean M SM

PloS one 20230130 1

This prospective quasi-experimental study from the NASAM (National Approach to Standardize and Improve Mechanical Ventilation) collaborative assessed the impact of evidence-based practices including subglottic suctioning, daily assessment for spontaneous awakening trial (SAT), spontaneous breathing trial (SBT), head of bed elevation, and avoidance of neuromuscular blockers unless otherwise indicated. The study outcomes included VAE (primary) and intensive care unit (ICU) mortality. Changes in da ...[more]

PMID: 36716310

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Project description:BackgroundMechanical ventilation services are an important driver of the high costs of intensive care. An optimal interaction between a patient and a ventilator is therefore paramount. Suboptimal interaction is present when patients repeatedly demand, but do not receive, breathing support from a mechanical ventilator (> 30 times in 3 min), also known as an ineffective effort event (IEEV). IEEVs are associated with increased hospital mortality prolonged intensive care stay, and prolonged time on ventilation and thus development of real-time analytics that identify IEEVs is essential. To assist decision-making about further development we estimate the potential cost-effectiveness of real-time analytics that identify ineffective effort events.MethodsWe developed a cost-effectiveness model combining a decision tree and Markov model for long-term outcomes with data on current care from a Greek hospital and literature. A lifetime horizon and a healthcare payer perspective were used. Uncertainty about the results was assessed using sensitivity and scenario analyses to examine the impact of varying parameters like the intensive care costs per day and the effectiveness of treatment of IEEVs.ResultsUse of the analytics could lead to reduced mortality (3% absolute reduction), increased quality adjusted life years (0.21 per patient) and cost-savings (€264 per patient) compared to current care. Moreover, cost-savings for hospitals and health improvements can be incurred even if the treatment's effectiveness is reduced from 30 to 10%. The estimated savings increase to €1,155 per patient in countries where costs of an intensive care day are high (e.g. the Netherlands). There is considerable headroom for development and the analytics generate savings when the price of the analytics per bed per year is below €7,307. Furthermore, even when the treatment's effectiveness is 10%, the probability that the analytics are cost-effective exceeds 90%.ConclusionsImplementing real-time analytics to identify ineffective effort events can lead to health and financial benefits. Therefore, it will be worthwhile to continue assessment of the effectiveness of the analytics in clinical practice and validate our findings. Eventually, their adoption in settings where costs of an intensive care day are high and ineffective efforts are frequent could yield a high return on investment.

Project description:AimsThe aim of this study was to perform a concept analysis of communication with mechanically ventilated patients in intensive care units and present a preliminary model for communication practice with these patients.DesignThe Im & Meleis approach for concept analysis guided the study.Search methodsA literature search was performed in January 2022 in MEDLINE, Embase, CINAHL, psycINFO and Scopus, limited to 1998-2022. The main medical subject headings search terms used were artificial respiration, communication and critical care. The search resulted in 10,698 unique references.Review methodsAfter a blinded review by two authors, 108 references were included. Core concepts and terminology related to communication with mechanically ventilated patients were defined by content analytic methods. The concepts were then grouped into main categories after proposing relationships between them. As a final step, a preliminary model for communication with mechanically ventilated patients was developed.ResultsWe identified 39 different phrases to describe the mechanically ventilated patient. A total of 60 relevant concepts describing the communication with mechanically ventilated patients in intensive care were identified. The concepts were categorized into five main categories in a conceptual map. The preliminary model encompasses the unique communication practice when interacting with mechanically ventilated patients in intensive care units.ConclusionHighlighting different perspectives of the communication between mechanically ventilated patients and providers through concept analysis has contributed to a deeper understanding of the phenomena and the complexity of communication when the patients have limited possibilities to express themselves.ImpactA clear definition of concepts is needed in the further development of guidelines and recommendations for patient care in intensive care, as well as in future research. The preliminary model will be tested further.Patient or public contributionNo patient or public contribution, as this is a concept analysis of previous research.

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Impact of a national collaborative project to improve the care of mechanically ventilated patients.

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Impact of a national collaborative project to improve the care of mechanically ventilated patients.

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