Version 1: Impact of a ventilator care bundle on critically ill mechanically ventilated patients at a tertiary care center in northern India

Introduction Effective implementation of a care bundle is proven to decrease the occurrence of VAE, duration of mechanical ventilation, and length of stay in any ICU. Hypothesis/Gap statement There are few studies from India on the compliance rate of the ventilator care bundle and its impact on Ventilator Associated Event (VAE) rate as well as ICU course. 

Aim We assessed the compliance rate to six components of the ventilator care bundle and its impact on the rate of VAE and ICU course of patients admitted to the Critical Care Medicine ward at our centre. 

Methodology This prospective, observational, single-center cohort study included 68 patients who received mechanical ventilation in a 20-bed, adult mixed medical-surgical ICU at a tertiary care institute. 

Results The median duration of mechanical ventilation was 9 days. The compliance to the ventilator care bundle was partial (<6 components) among 52 patients while full compliance was observed in only 16 patients. The overall percentage compliance to six ventilator care bundle components was 99% for PUD-P followed by 98% for Assessment of Sedation (AS), 94% for Head of Bed Elevation (HoBE), 86% for Daily Oral Care with Chlorhexidine(O-CHX), 82% for Subglottic Suction Drainage (SSD) and 72% for Deep Venous Thrombosis Prophylaxis (DVT-P). The median duration of mechanical ventilation & length of stay in ICU decreased to 6 & 11 days respectively among patients with full bundle compliance. The baseline VAE rate was 11.3/1000 ventilator-days which decreased to 9.2/1000 ventilator-days during the study. Acinetobacter baumannii was the most common isolate (n= 37) out of which 90% were carbapenem resistant. 

Conclusion Full bundle compliance was observed to be associated with a reduction in VAE rate as well as the duration of mechanical ventilation and length of stay in the ICU.