抄録
Ventilator-associated pneumonia (VAP) is the most serious but preventable infectious complication in intensive care unit. Ventilator care bundle has been proposed as a possible tool in preventing VAP. Scarce data, however, have been reported regarding the bundle, and no studies exist specifically in Japanese practice. We conducted a 2-year prospective survey to elucidate the adherence rate and efficacy of ventilator bundle in a single-institute. We investigated the adherence rate of the 4 components of ventilator bundle and incidence of VAP in 109 intensive care patients receiving mechanical ventilation >48 hours on daily basis for 7 days starting the initiation of mechanical ventilation. The 4 components of the bundle included: 1) head of bed (HOB) elevation, 2) sedation vacation (daily discontinuation of sedatives), 3) peptic ulcer prophylaxis, and 4) deep venous thrombosis prophylaxis. The adherence rates of deep vein thrombosis prophylaxis (P = 0.02), and all of the 4 components (P = 0.04) were increased significantly in year 2007 compared with those of year 2006. When evaluating the adherence in the first 48 hours, the rate of HOB elevation improved significantly in year 2007 compared with that of year 2006 (P = 0.02). The adherence rates of HOB elevation and sedation vacation component were relatively lower than the other two components. The incidence of VAP per 1,000 ventilator days decreased from 12.7 in year 2006 to 5.2 in year 2007. Improvement in the adherence rate, specifically focusing on HOB elevation and sedation vacation components, should further be directed by using educational approach for healthcare personnel and application of protocolized care.
