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BJA Advance Access published online on May 20, 2009
British Journal of Anaesthesia, doi:10.1093/bja/aep114
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Effects of staff training on the care of mechanically ventilated patients: a prospective cohort study

F. Bloos1,*, S. Müller1, A. Harz1, M. Gugel1, D. Geil1, K. Egerland1, K. Reinhart1 and G. Marx1,2

1 Department of Anaesthesiology and Intensive Care Medicine, University Hospital Jena, Erlanger Allee 101, 07747 Jena, Germany
2 Department of Surgical Intensive Care Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany

* Corresponding author. E-mail: frank.bloos{at}med.uni-jena.de

Background: Adherence to guidelines to avoid complications associated with mechanical ventilation is often incomplete. The goal of this study was to assess whether staff training in pre-defined interventions (bundle) improves the quality of care in mechanically ventilated patients.

Methods: This study was performed on a 50-bed intensive care unit of a tertiary care university hospital. Application of a ventilator bundle consisting of semirecumbent positioning, lung protective ventilation in patients with acute lung injury (ALI), ulcer prophylaxis, and deep vein thrombosis prophylaxis (DVTP) was assessed before and after staff training in post-surgical patients requiring mechanical ventilation for at least 24 h.

Results: A total of 133 patients before and 141 patients after staff training were included. Overall bundle adherence increased from 15 to 33.8% (P<0.001). Semirecumbent position was achieved in 24.9% of patient days before and 46.9% of patient days after staff training (P<0.001). Administration of DVTP increased from 89.5 to 91.5% (P=0.048). Ulcer prophylaxis of >90% was achieved in both groups. Median tidal volume in patients with ALI remained unaltered. Days on mechanical ventilation were reduced from 6 (interquartile range 2.0–15.0) to 4 (2.0–9.0) (P=0.017). Rate of ventilator-associated pneumonia (VAP), ICU length of stay, and ICU mortality remained unaffected. In patients with VAP, the median ICU length of stay was reduced by 9 days (P=0.04).

Conclusions: Staff training by an ICU change team improved compliance to a pre-defined ventilator bundle. This led to a reduction in the days spent on mechanical ventilation, despite incomplete bundle implementation.

Keywords: audit, trainings; complications, respiratory; intensive care, pulmonary; ventilation, mechanical


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E-letters:

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Equating outcome benefit to poor care bundle compliance may be misleading
Peter J O'Brien, et al.
British Journal of Anaesthesia, 9 Sep 2009 [Full text]
Moderate application of a ventilator bundle was associated with improved outcome
Frank Bloos, et al.
British Journal of Anaesthesia, 14 Oct 2009 [Full text]

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