Prevention of Intensive Care Unit-acquired Pneumonia

Michael Klompas, MD, MPH

Disclosures

Semin Respir Crit Care Med. 2019;40(4):548-557. 

In This Article

Ventilator Bundles

One bright note is that ventilator bundle implementations do appear on balance to be beneficial for patients. Many hospitals have reported lower VAP rates after implementing prevention bundles.[109] These have always been subject to question because of the difficulty knowing if lower VAP rates in these before–after or time-series analyses were due to true decreases in disease versus stricter application of subjective and nonspecific VAP definitions over time.[19] A recent meta-analysis, however, addressed this question by evaluating the association between bundle implementations and mortality.[110] Using data from 13 hospitals, the authors reported that ventilator bundle implementations were associated with a 10% decrease in the odds of death. While the before–after/time-series design of all the contributing studies still makes it possible that some of the signal may be due to temporal trends unrelated to bundles,[17] this study at least allows for the possibility that our many efforts to prevent pneumonia in critically ill populations are proving beneficial. In light of the foregoing analysis of individual strategies to prevent ICU-acquired pneumonia, it is most likely that the salutary impact of bundles is primarily being driven by the sedation management and early extubation components (i.e., minimizing sedation, spontaneous awakening, and breathing trials).[31] This is further borne out by the complementary results of "ABCDE" bundle implementation reports (minimizing sedation, daily coordinated spontaneous awakening and breathing trials, delirium screening, and early mobilization).[39–43]

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