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Its ironic when you think about it

a mechanism

designed to keep patients alive can actually make them sicker and even kill them.

Were talking about ventilators, or, more speci cally, ventilator-associated pneumonia (VAP). Most surgical patients undergo general anesthetic for their procedures and are then extubated in the operating room at the end of surgery. Critically ill patients, however, remain intubated after being transported from the operating room to the ICU. Stop and think for a second about how long those patients might remain on ventilators. As hours and days tick by, the risk of VAP grows exponentially.

VAP typically occurs after 48 hours of intubation and is a leading cause of death among patients who contract nosocomial infections. In addition to prolonging a patients hospital stay, VAP also adds an estimated cost of $40,000 per admission. Ultimately, approximately 46 percent of patients who develop VAP will not survive.

By Kimberly Haines, RN

In an e ort to reduce post-operative complications, the Surgical Care Improvement Project (SCIP) has targeted post-operative VAP as one of four areas requiring improvement. According to SCIP, sta education regarding best practices and new technologies as well as e ective communication leads to quality improvement. The organization also states that standardized 2 processes lead to improved consistent care and better outcomes. The prevention of ventilator-associated pneumonia is also a goal of the Institute of Healthcare Improvement (IHI) 100,000 Lives Campaign. The organization has put together a how-to guide to prevent VAP. The guide advocates the use of a ventilator bundle, which is a grouping of best practices that result in signi cant improvement in the prevention of VAP. Some facilities have seen a 45 percent decrease in VAP using this bundled approach. The IHI bundle was designed to increase adherence to basic 1 preventative measures, and includes the following therapies: Elevating the head of the bed Elevating the head of the hospital bed 30 degrees to 45 degrees improves ventilation and reduces the likelihood of atelectasis and aspiration of gastric contents. Deep vein thrombosis (DVT) prophylaxis The rate of DVT increases in sedentary sedated patients. Peptic ulcer prophylaxis The mortality rate of patients increases ve times in ocumented d occurrences of gastrointestinal bleeding related to stress ulcerations. Aspiration of gastric contents might precipitate pneumonia. Sedation vacation Daily interruption of sedation allows assessment of the patients readiness to be extubated. A reduced sedative state also allows the patient to assist in extubation by controlling secretions and coughing. Patient ventilation time decreased almost 50 percent using this technique. While the IHI acknowledges additional therapies such as subglottic suctioning and oral care can also decrease the risk of VAP, these therapies were not included in the IHI bundle. The bundle includes only therapies the IHI felt 1 could be implemented rapidly and were readily available at all facilities. The prevention of ventilator-associated pneumonia requires a multidisciplinary approach. The next time an intubated patient is transported to the ICU, theses therapies should be considered. They might save the patients life.
References: 1 Institute for Healthcare Improvement. Getting Started Kit: Prevent Ventilator Associated Pneumonia. How-to Guide. Available at: http://www.ihi.org. Accessed May 24, 2007. 2 Surgical Care Improvement Project. Respiratory. Available at: http://medqic.org/scip. Accessed May 24, 2007.

About the author

Kimberly Haines, currently a clinical nurse consultant, has been an RN for 13 years. Previously, she was a sta nurse at a number of acute care facilities and ambulatory surgery centers.