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

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...

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Detalles Bibliográficos
Autores principales: Arabi, Yaseen M., Al Aseri, Zohair, Alsaawi, Abdulmohsen, Al Khathaami, Ali M., Al Qasim, Eman, Alzahrani, Abdullah A., Al Qarni, Mohammed, Abdukahil, Sheryl Ann I., Al-Dorzi, Hasan M., Alattasi, Abdulaleem, Mandourah, Yasser, Alaama, Tareef Y., Alabdulaali, Mohammed K., Alqahtani, Abdulrahman, Shuaibi, Ahmad, Al Qarni, Ali, Alkatheri, Mufareh, Al Hazme, Raed H., Vishwakarma, Ramesh Kumar, Aldibasi, Omar, Alshahrani, Mohammed Saeed, Attia, Ashraf, Alharthy, Abdulrahman, Mady, Ahmed, Abdelrahman, Basheer Abdullah, Mhawish, Huda Ahmad, Abdallah, Hassan Ahmad, Al-Hameed, Fahad, Alghamdi, Khalid, Alghamdi, Adnan, Almekhlafi, Ghaleb A., Qasim, Saleh Abdorabo Haider, Al Haji, Hussain Ali, Al Mutairi, Mohammed, Tashkandi, Nabiha, Alabbasi, Shatha Othman, Al Shehri, Tariq, Moftah, Emad, Kalantan, Basim, Matroud, Amal, Naidu, Brintha, Al Zayer, Salha, Burrows, Victoria, Said, Zayneb, Soomro, Naseer Ahmed, Yousef, Moawea Hesham, Fattouh, Ayman Abdulmonem, Tahoon, Manar Aboelkhair, Muhammad, Majdi, Alruwili, Afifah Muslim, Al Hanafi, Hossam Ahmed, Dandekar, Pramodini B., Ibrahim, Kamel, AlHomsi, Mwafaq, Al Harbi, Asma Rayan, Saleem, Adel, Masih, Ejaz, Al Rashidi, Nowayer Monawer, Amanatullah, Aslam Khan, Al Mubarak, Jaffar, Al Radwan, Amro Ali Abduljalil, Al Hassan, Ali, Al Muoalad, Sadiyah, Alzahrani, Ammar Abdullah, Chalabi, Jamal, Qureshi, Ahmad, Al Ansari, Maryam, Sallam, Hend, Elhazmi, Alyaa, Alkhaldi, Fawziah, Malibary, Abdulrauf, Ababtain, Abdullah, Latif, Asad, Berenholtz, Sean M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Research Article
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9886257/
https://www.ncbi.nlm.nih.gov/pubmed/36716310
http://dx.doi.org/10.1371/journal.pone.0280744
Descripción
Sumario: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).

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