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Multicenter Prospective Evaluation of the Ventilator Bundle in Injured Patients

Principal Investigator: Martin A. Croce, MD
Lead Institution: University of Tennessee Health Science Center
Participating Centers: Brown Medical School, Medical College of Wisconsin, University of California at San Diego

Ventilator associated pneumonia (VAP) is the most common serious infection that occurs in severely injured patients. For those who develop VAP, approximately 20% will die. While the mainstay of treatment of VAP remains antibiotic therapy, the emphasis from healthcare organizations has been VAP prevention. To that end, the Institute for Healthcare Improvement has advocated a “bundle” of care maneuvers to help prevent VAP. Unfortunately, there is little evidence to support these “bundles.”

Furthermore, the Centers for Medicare and Medicaid Services has determined that VAP may be preventable, and has threatened to reduce or eliminate payment when a patient develops VAP. Another issue with VAP is the diagnostic method. Despite its relatively common occurrence, there is not uniform agreement on the diagnostic method, and the method used may impact VAP rates – thus making evaluation of the “bundle” extremely difficult.

The present study will involve a consortium of busy, dedicated, and geographically diverse trauma centers. It is designed to determine the impact of the “Ventilator Bundle” on the incidence of VAP after injury, and to determine the effect of the VAP diagnostic criteria on the incidence of VAP after injury. This is a prospective observational study that does not involve treatment. From the collected data, we hope to specifically identify the most useful parts of the Ventilator Bundle for VAP prevention. To do this, data from each of six institutions will be studied both before and after bundle implementation. VAP rates will then be compared. Other data will also be collected to evaluate the impact of pre-injury general health and injury characteristics on the development of VAP and the diagnostic method. We expect that consistent application of the bundle will reduce VAP incidence in injured patients, but other unalterable patient and injury factors will make VAP elimination virtually impossible.

Publications

Croce M, Brasel K, Coimbra R, Adams, Jr. C, Miller P, Pasquale M. National Trauma Institute prospective evaluation of the ventilator bundle in trauma patients: Does it really work? J Trauma Acute Care Surg. 2013;74(2):354-362.
DOI: 10.1097/ta.0b013e31827a0c65