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Assessing the impact of introducing the 'ventilator bundle' on outcomes for mechanically ventilated patients

Background

The concept of bundles was developed by the Institute for Healthcare Improvement. Individual bundle elements are built on evidence-based practice, and the bundle concept is that when these elements are executed together they produce better outcomes than in isolation. There is, however, limited evidence linking the use of bundles to demonstrable changes in patient outcomes. As a preliminary analysis to inform a multicentre evaluation, we explored the effect of the introduction of the 'ventilator bundle' on the outcomes for mechanically ventilated patients in a single critical care unit.

Methods

Data were extracted for mechanically ventilated admissions from a single unit participating in the Case Mix Programme that was an early adopter of the ventilator bundle. A risk prediction model was developed using data from admissions during the 3.5 years prior to the introduction of the bundle and applied to admissions during the 3 years since introduction to estimate the cumulative excess mortality (observed minus expected deaths).

Results

There were 762 ventilated admissions prior to the introduction of the bundle and 618 since. The cumulative excess mortality plot suggested a reduction in mortality after introduction of the bundle (Figure 1) but this was not statistically significant (relative risk reduction 10.9%, 95% confidence interval -10.2% to 31.8%).

figure1

Figure 1

Interpretation

The results suggest that it will be beneficial to carry out a multicentre evaluation of the ventilator bundle in Case Mix Programme units, and will inform the design of this study.

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Harrison, D., Rowan, K. Assessing the impact of introducing the 'ventilator bundle' on outcomes for mechanically ventilated patients. Crit Care 11, P177 (2007). https://doi.org/10.1186/cc5337

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Keywords

  • Critical Care
  • Single Unit
  • Risk Prediction
  • Relative Risk Reduction
  • Early Adopter