20-Interdisciplinary, Synergistic, Multimodal Interventions Decrease Ventilator-Associated Events
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Pulmonary, Quality and Patient Safety, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Christine Swartzman


Introduction/Hypothesis: Reducing ventilator-associated events (VAE) requires interventions to decrease ventilator time and prevent infections. Although an 800-bed Level I trauma center already used evidence based strategies, including the A2F bundle, head of bed elevation, subglottic suction endotracheal tubes, routine oral care and toothbrushing, and low tidal volume ventilation, rates for infection-related ventilator-associated complications (IVAC) and possible ventilator-associated pneumonia (PVAP) were high. The authors hypothesized that a synergistic, multimodal approach was needed to reduce IVAC and PVAP rates.

Methods: Combined rates for IVAC plus PVAP ('IVAC Plus') were compared for the periods from June 2017-May 2019 (pre) vs June 2019-May 2020 (post). In Fall 2018, a team of nurses, respiratory therapists (RT), clinical nurse specialists, infection preventionists, and intensivist leaders developed and implemented multiple interventions over a period of fourteen months. Daily awakening and breathing trials were audited 'at the elbow' each shift. An intensive review for nursing and RT was conducted on all PVAP cases. An intensivist review for potential causes of IVACs was instituted to determine if non-pulmonary, non-infectious, or non-preventable factors may have contributed. The multisystem ICU performed an improvement cycle for early mobility, for which the protocol was added to the electronic health record. Because many IVAC plus cases occurred in patients with frequent transports that required supine positioning, the trauma and neuro ICUs implemented a transport bundle which included oral care, deep subglottic suctioning, and cuff pressure monitoring just prior to and immediately following transports. Finally, contaminated suction regulators were replaced, thus a guideline for routine cleaning and maintenance was implemented.

Results: The mean 'IVAC Plus' rate was 6.47/1000 ventilator days in the pre-intervention and 3.79/1000 ventilator days in the post-intervention periods (p=0.004) with a 41% rate reduction and a corresponding decrease in monthly variability, but no difference in average ventilator length of stay.

Conclusions: An interdisciplinary, multimodal intervention to decrease IVAC Plus events achieved significant and sustained results over fourteen months.


Meta Tag
Content Type Presentation
Knowledge Area Pulmonary
Knowledge Area Quality and Patient Safety
Knowledge Level Advanced
Membership Level Select
Tag Ventilation
Tag Ventilator Associated Pneumonia VAP
Tag Length of Stay
Year 2021
Ventilator-associated events
ICU liberation bundle
Head of bed elevation
Subglottic suction endotracheal tubes
Program expansion


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