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. 2023 Jun 14;3(4):352-364.
doi: 10.1016/j.jointm.2023.04.004. eCollection 2023 Oct 31.

Prevention of ventilator-associated pneumonia through care bundles: A systematic review and meta-analysis

Raquel Martinez-Reviejo  1 , Sofia Tejada  1   2 , Miia Jansson  3   4 , Alfonsina Ruiz-Spinelli  5   6 , Sergio Ramirez-Estrada  7 , Duygu Ege  8 , Tarsila Vieceli  9 , Bert Maertens  10 , Stijn Blot  10 , Jordi Rello  1   2   11   6
Affiliations

Prevention of ventilator-associated pneumonia through care bundles: A systematic review and meta-analysis

Raquel Martinez-Reviejo et al. J Intensive Med. .

Abstract

Background: Ventilator-associated pneumonia (VAP) represents a common hospital-acquired infection among mechanically ventilated patients. We summarized evidence concerning ventilator care bundles to prevent VAP.

Methods: A systematic review and meta-analysis were performed. Randomized controlled trials and controlled observational studies of adults undergoing mechanical ventilation (MV) for at least 48 h were considered for inclusion. Outcomes of interest were the number of VAP episodes, duration of MV, hospital and intensive care unit (ICU) length of stay, and mortality. A systematic search was conducted in the MEDLINE, the Cochrane Library, and the Web of Science between 1985 and 2022. Results are reported as odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI). The PROSPERO registration number is CRD42022341780.

Results: Thirty-six studies including 116,873 MV participants met the inclusion criteria. A total of 84,031 participants underwent care bundles for VAP prevention. The most reported component of the ventilator bundle was head-of-bed elevation (n=83,146), followed by oral care (n=80,787). A reduction in the number of VAP episodes was observed among those receiving ventilator care bundles, compared with the non-care bundle group (OR=0.42, 95% CI: 0.33, 0.54). Additionally, the implementation of care bundles decreased the duration of MV (MD=-0.59, 95% CI: -1.03, -0.15) and hospital length of stay (MD=-1.24, 95% CI: -2.30, -0.18) in studies where educational activities were part of the bundle. Data regarding mortality were inconclusive.

Conclusions: The implementation of ventilator care bundles reduced the number of VAP episodes and the duration of MV in adult ICUs. Their application in combination with educational activities seemed to improve clinical outcomes.

Keywords: Hospital-acquired pneumonia; Prevention; Quality improvement intervention; Ventilator bundle.

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Figures

Figure 1:
Figure 1
PRISMA flow diagram of the study selection. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-analyses.
Figure 2:
Figure 2
Forest plot based on VAP incidence from health centers that carried out educational interventions for implementing care bundles and health centers that did not conduct any educational intervention. VAP: Ventilator-associated pneumonia; CI: Confidence interval.
Figure 3:
Figure 3
Forest plot based on the duration of MV (days) in health centers that carried out educational interventions for implementing care bundles and health centers that did not conduct any educational intervention. MV: Mechanical ventilation; CI: Confidence interval.
Figure 4:
Figure 4
Forest plot based on the duration of MV (days) in studies where baseline measures were conducted in the non-care bundle group and studies that did not. MV: Mechanical ventilation; CI: Confidence interval.
Figure 5:
Figure 5
Forest plot based on hospital length of stay in health centers that carried out educational interventions for implementing care bundles and health centers that did not conduct any educational intervention. CI: Confidence interval.
Figure 6:
Figure 6
Forest plot based on hospital mortality in studies where baseline measures were conducted in the non-care bundle group and studies that did not. CI: Confidence interval.
See this image and copyright information in PMC

References

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