Ventilator Bundles

Dr. Taufan Primawan

Kepala Instalasi ICU RSIA Hermina Bekasi

Ventilator Bundles
 Concept of a bundle
 Several elements done
simultaneously
 Consistently result in better
outcomes
 Greater quality than elements
done independently
 Systems must ensure all
elements applied to all patients
 Limit bundle elements
Ventilator Bundle
Performance Improvement

 What we can accomplish?

 To achieve greater than 95%
on the ventilator bundle.
 How will we know that a change
is an improvement?
 Monitor percent of ventilator
patients receiving all five
bundle elements
 Ventilator Bundle
Performance Improvement
 What changes can we make that will result
in improvement?
 Improve education by distributing a
FACT SHEET
 Hold in-services for bedside providers

 Improve communication among

providers by using the DAILY GOALS
SHEET during rounds in the ICU.
 Ventilator Bundle
Performance Improvement
 What changes can we make that will
result in improvement? (cont.)
 Create independent redundancy to
insure that patients receive the
processes of care included in the
ventilator bundle.
 Conduct glucose control rounds
where you review a patient who is
on the protocol
Ventilator Bundle Elements

1. HOB elevation
2. Appropriate DVT prophylaxis
3. Appropriate PUD prophylaxis
4. Appropriate sedation
5. Assessment of readiness to
extubate

DAILY EVALUATION !!
 1. HOB Elevation
 HOB elevated greater than 30
degrees
 Reduces frequency and risk of
nosocomial pneumonia
 Simple, no-cost intervention
 Incidence of aspirations reduced
30%
 Vent and ICU LOS reduced
 2. Appropriate DVT
Prophylaxis
 Thromboprophylaxis effective in
preventing DVT
 Multiple methods of
thromboprophylaxis
 Unfractionated heparin

 Heparin

 Mechanical prophylaxis (TED

hose, sequential compression)
 Baseline incidence of DVT at 30%
 3. Appropriate PUD
Prophylaxis
 Reduces risk of upper GI bleeding
 Risk increased in:
 Mechanical ventilation greater
than 48 hours
 Coagulopathy

 No specific therapy
 4. Appropriate Sedation

 Daily interruption decreases

vent LOS
 Vent LOS reduced by 33%

 ICU LOS reduced by 35 %

 Hold sedation daily until patient

can follow commands
 5. Assessment of Readiness
to Extubate
 Reduce vent LOS, complications,
and ICU costs
 Daily screening of respiratory
function
 Spontaneous breathing trials

 Vent LOS reduced by 1.5 days

 Reduced self extubation,
reintubation, trach, prolonged
mechanical ventilation
 No baseline data
 Systems of
Independent redundancy
 To incorporate multiple independent
triggers into the existing system and
 improve compliance with the vent
bundle
 Add triggers to the charting system to
query the RN/respiratory therapist
when documenting:
 Is HOB elevated 30 degrees?

 Is patient receiving DVT prophylaxis

Systems of
Independent redundancy
 Monitor performance for the
ventilator bundle
 Print a run chart of performance
for vent bundle over time.
 Plan meeting with team
 Evaluate opportunities to further
improve performance
Fact Sheet
 Head of bed (HOB) elevation
greater than 30 degrees
reduces the frequency and risk
for nosocomial pneumonia
compared to supine position.
 The use of thromboprophylaxis
is effective for preventing deep
venous thrombosis (DVT).
 The use of peptic ulcer disease
(PUD) prophylaxis reduces the
risk of upper gastrointestinal
bleeding.
 Fact Sheet
QUALITY ADVERSE COSTS
MEASURE EVENTS
Elevate HOB xx deaths $xx
xx hospital
days
DVT xx deaths $xx
prophylaxis xx hospital
days
PUD xx deaths $xx
prophylaxis xx ICU
Appropriate Xx ICU days $xx
sedation
 Additional Elements for Future
Implementation
 Appropriate Glucose Control
 Intensive insulin therapy
 Maintain blood glucose less than
110 mg/deciliter
 Decrease morbidity and morality
 Gastric Decontamination
 Reduce colonization with resistant
gram negative aerobic bacteria
 Reduce ICU and hospital mortality
Ventilator Bundles
 Ventilator bundles and performance
improvement
 Elements of a ventilator bundle
 Systems of independent redundancy
 Fact Sheet
 Additional elements for future
implementation