Implementing the comprehensive unit-based safety program model to improve the management of mechanically ventilated patients in Saudi Arabia
Implementing the comprehensive unit-based safety program model to improve the management of mechanically ventilated patients in Saudi Arabia
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DOI：
10.1016/j.ajic.2018.06.022
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发表时间：
2019-01-01
影响因子：
4.9
通讯作者：
Arabi, Yaseen M.
中科院分区：
文献类型：
--
作者：
Khan, Raymond M.;Al-Juaid, Maha;Arabi, Yaseen M.
背景：呼吸机相关事件在机械通气患者中很常见。它们与机械通气天数更长、重症监护病房（ICU）住院时间更长以及死亡风险增加有关。理论上，预防呼吸机相关事件的干预措施也应降低相关发病率。我们评估了以综合单元为基础的安全计划方法来改善机械通气患者的护理。方法：对2015年10月1日至2016年10月31日期间入住ICU的所有机械通气患者，按照国家医疗安全网络标准前瞻性监测呼吸机相关事件的发生情况。一个过程护理包（气管内插管声门下吸引，床头抬高>= 30度，目标镇静评分，每日自发觉醒试验，自发呼吸试验），每日谵妄评估，并制定了早期活动方案。记录了捆绑依从性、呼吸机相关事件发生率、ICU住院时间和死亡率。该数据库允许查看所有参与站点的当前费率、趋势和平均值。结果：在研究期间，2321例患者入住ICU， 1231例患者需要机械通气（10,342呼吸机日）。有115例呼吸机相关事件：82例呼吸机相关疾病，15例感染相关呼吸机相关疾病，18例可能的呼吸机相关肺炎。ICU患者死亡率为13.3%，而机械通气患者发生呼吸机相关事件的死亡率为28.7% （P = 0.0001）。自发觉醒试验（51.5%-76.9%,P = 0.0008）和自发呼吸试验（54.2%-72.2%,P = 0.02）的依从性增加，感染相关呼吸机相关疾病（每1000天4.2-3.5例）、可能的呼吸机相关肺炎病例（每1000天2.1-1.7例）、ICU死亡率（45.3%-19.1%,P = 0.045）和呼吸机相关事件相关死亡率（33.3%-8.3%,P < 0.37）下降。物理治疗参与率和活动能力分别为60.8%和26.4%。结论：多管齐下的方案如综合单元安全方案的实施可以改善机械通气患者的护理过程和结果。(C) 2018年中国感染控制与流行病学专业人员协会Elsevier Inc.出版。版权所有。
Background: Ventilator-associated events are common in mechanically ventilated patients. They are associated with more days on mechanical ventilation, longer intensive care unit (ICU) stay, and increased risk of mortality. Theoretically, interventions that prevent ventilator-associated events should also reduce associated morbidity. We evaluated the Comprehensive Unit-based Safety Program approach to improve the care of mechanically ventilated patients.Methods: All mechanically ventilated patients admitted to the ICU between October 1, 2015, and October 31, 2016, were prospectively monitored for the development of ventilator-associated events according to the National Healthcare Safety Network criteria. A process care bundle (endotracheal intubation with subglottic suctioning, head-of-bed elevation >= 30 degrees, target sedation scores, daily spontaneous awakening trials, spontaneous breathing trials), daily delirium assessment, and an early mobility protocol were instituted. The bundle compliance, ventilator-associated events rates, ICU length of stay, and mortality rate were noted. The database allowed viewing of current rates, trends, and averages of all participating sites.Results: In the study period, 2,321 patients were admitted to the ICU, and 1,231 required mechanical ventilation (10,342 ventilator days). There were 115 ventilator-associated events: 82 ventilator-associated conditions, 15 infection-related ventilator-associated conditions, and 18 possible cases of ventilator-associated pneumonia. The ICU mortality rate was 13.3%, compared with 28.7% for those mechanically ventilated patients with ventilator-associated events (P = .0001). There was increased compliance for spontaneous awakening trials (51.5%-76.9%, P = .0008) and spontaneous breathing trials (54.2%-72.2%, P = .02) and a decrease in infection-related ventilator-associated conditions (4.2-3.5 per 1,000 days), possible cases of ventilator-associated pneumonia (2.1-1.7 per 1,000 days), ICU mortality (45.3%-19.1%, P = .045), and ventilator-associated events associated mortality rates (33.3%-8.3%, P < .37). Physical therapy participation and mobility were 60.8% and 26.4%, respectively.Conclusion: The implementation of a multipronged program like the Comprehensive Unit-based Safety Program could improve the care processes and outcomes of mechanically ventilated patients. (C) 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.