Impact of a national collaborative project to improve the care of mechanically ventilated patients.

Autor: Arabi YM; Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia., Al Aseri Z; Department of Emergency, Department of Intensive Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia., Alsaawi A; Department of Medical Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Al Khathaami AM; Quality and Patient Safety Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Al Qasim E; Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia., Alzahrani AA; Quality and Patient Safety Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Al Qarni M; Quality and Patient Safety Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Abdukahil SAI; Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia., Al-Dorzi HM; Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia., Alattasi A; Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia., Mandourah Y; Department of Military Medical Services, Ministry of Defense, Riyadh, Saudi Arabia., Alaama TY; Deputyship of Curative Services, Ministry of Health, Riyadh, Saudi Arabia., Alabdulaali MK; Adaa Health Program, Ministry of Health, Riyadh, Saudi Arabia., Alqahtani A; Executive Director of Medical Affairs Department, Ministry of Health, King Saud Medical City, Riyadh, Saudi Arabia., Shuaibi A; Department of Medical Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Dammam, Saudi Arabia., Al Qarni A; Department of Medicine, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Al Ahsa, Saudi Arabia., Alkatheri M; Quality and Patient Safety Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Al Hazme RH; Department of Health Informatics, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.; Department of Biomedical Informatics, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, United States of America., Vishwakarma RK; Department of Bioinformatics and Biostatistics, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.; Statistics Department, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium., Aldibasi O; Department of Bioinformatics and Biostatistics, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Alshahrani MS; Department of Critical Care, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia., Attia A; Department of Critical Care, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia., Alharthy A; Department of Intensive Care, King Saud Medical City, Riyadh, Saudi Arabia., Mady A; Department of Intensive Care, King Saud Medical City, Riyadh, Saudi Arabia.; Department of Anesthesiology and Intensive Care, Tanta University Hospital, Tanta, Egypt., Abdelrahman BA; Department of Intensive Care, King Saud Medical City, Riyadh, Saudi Arabia., Mhawish HA; Department of Intensive Care, King Saud Medical City, Riyadh, Saudi Arabia., Abdallah HA; Department of Intensive Care, King Saud Medical City, Riyadh, Saudi Arabia., Al-Hameed F; Department of Intensive Care, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia., Alghamdi K; Department of Intensive Care, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia., Alghamdi A; Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia., Almekhlafi GA; Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia., Qasim SAH; Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia., Al Haji HA; Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Al Mutairi M; Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Tashkandi N; Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Alabbasi SO; Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Al Shehri T; Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Moftah E; Rehabilitation Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Kalantan B; Rehabilitation Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Matroud A; Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Naidu B; Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Al Zayer S; Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Burrows V; Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Said Z; Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Soomro NA; Department of Intensive Care, Arar Central Hospital, Arar, Saudi Arabia., Yousef MH; Department of Intensive Care, Alrass General Hospital, AlQassim, Saudi Arabia., Fattouh AA; Department of Intensive Care, King Fahad Hospital, Al Baha, Saudi Arabia., Tahoon MA; Department of Intensive Care, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia., Muhammad M; Department of Intensive Care, Gurayat General Hospital, AlGurayat, Saudi Arabia., Alruwili AM; Nursing Services, Prince Mohammed Bin Abdulaziz Hospital, Sakaka, Saudi Arabia., Al Hanafi HA; Department of Intensive Care, King Salman Hospital, Riyadh, Saudi Arabia., Dandekar PB; Department of Intensive Care, King Abdullah Hospital, Bisha, Saudi Arabia., Ibrahim K; Department of Intensive Care, King Khalid General Hospital, Majmaah, Saudi Arabia., AlHomsi M; Department of Intensive Care, Buraydah Central Hospital, AlQassim, Saudi Arabia., Al Harbi AR; Department of Intensive Care, King Fahad Specialist Hospital, AlQassim, Saudi Arabia., Saleem A; Department of Intensive Care, King Faisal Hospital, Makkah, Saudi Arabia., Masih E; Department of Intensive Care, King Khaled Hospital, Tabuk, Saudi Arabia., Al Rashidi NM; Department of Intensive Care, King Khaled Hospital, Tabuk, Saudi Arabia., Amanatullah AK; Department of Intensive Care, King Khalid Hospital, Hail, Saudi Arabia., Al Mubarak J; Respiratory Services, King Khalid General Hospital, Hafer Al Batin, Saudi Arabia., Al Radwan AAA; Department of Intensive Care, Jubayl General Hospital, Jubayl, Saudi Arabia., Al Hassan A; Department of Intensive Care, King Khalid Hospital, Najran, Saudi Arabia., Al Muoalad S; Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia., Alzahrani AA; Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia., Chalabi J; Department of Intensive Care, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Al Ahsa, Saudi Arabia., Qureshi A; Department of Intensive Care, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Madinah, Saudi Arabia., Al Ansari M; Department of Intensive Care, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Dammam, Saudi Arabia., Sallam H; Department of Intensive Care, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia., Elhazmi A; Department of Intensive Care, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia., Alkhaldi F; Nursing Services, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia., Malibary A; Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia., Ababtain A; Respiratory Services, Royal Commission Health Services Program, Jubayl, Saudi Arabia., Latif A; Department of Anesthesiology and Critical Care Medicine, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America., Berenholtz SM; Department of Anesthesiology and Critical Care Medicine, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2023 Jan 30; Vol. 18 (1), pp. e0280744. Date of Electronic Publication: 2023 Jan 30 (Print Publication: 2023).
DOI: 10.1371/journal.pone.0280744
Abstrakt: This prospective quasi-experimental study from the NASAM (National Approach to Standardize and Improve Mechanical Ventilation) collaborative assessed the impact of evidence-based practices including subglottic suctioning, daily assessment for spontaneous awakening trial (SAT), spontaneous breathing trial (SBT), head of bed elevation, and avoidance of neuromuscular blockers unless otherwise indicated. The study outcomes included VAE (primary) and intensive care unit (ICU) mortality. Changes in daily care process measures and outcomes were evaluated using repeated measures mixed modeling. The results were reported as incident rate ratio (IRR) for each additional month with 95% confidence interval (CI). A comprehensive program that included education on evidence-based practices for optimal care of mechanically ventilated patients with real-time benchmarking of daily care process measures to drive improvement in forty-two ICUs from 26 hospitals in Saudi Arabia (>27,000 days of observation). Compliance with subglottic suctioning, SAT and SBT increased monthly during the project by 3.5%, 2.1% and 1.9%, respectively (IRR 1.035, 95%CI 1.007-1.064, p = 0.0148; 1.021, 95% CI 1.010-1.032, p = 0.0003; and 1.019, 95%CI 1.009-1.029, p = 0.0001, respectively). The use of neuromuscular blockers decreased monthly by 2.5% (IRR 0.975, 95%CI 0.953-0.998, p = 0.0341). The compliance with head of bed elevation was high at baseline and did not change over time. Based on data for 83153 ventilator days, VAE rate was 15.2/1000 ventilator day (95%CI 12.6-18.1) at baseline and did not change during the project (IRR 1.019, 95%CI 0.985-1.053, p = 0.2812). Based on data for 8523 patients; the mortality was 30.4% (95%CI 27.4-33.6) at baseline, and decreased monthly during the project by 1.6% (IRR 0.984, 95%CI 0.973-0.996, p = 0.0067). A national quality improvement collaborative was associated with improvements in daily care processes. These changes were associated with a reduction in mortality but not VAEs. Registration The study is registered in clinicaltrials.gov (NCT03790150).
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2023 Arabi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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