TY - JOUR
T1 - Impact of a national collaborative project to improve the care of mechanically ventilated patients
AU - Saudi Critical Care Trials Group
AU - Arabi, Yaseen M.
AU - Al Aseri, Zohair
AU - Alsaawi, Abdulmohsen
AU - Al Khathaami, Ali M.
AU - Al Qasim, Eman
AU - Alzahrani, Abdullah A.
AU - Al Qarni, Mohammed
AU - Abdukahil, Sheryl Ann I.
AU - Al-Dorzi, Hasan M.
AU - Alattasi, Abdulaleem
AU - Mandourah, Yasser
AU - Alaama, Tareef Y.
AU - Alabdulaali, Mohammed K.
AU - Alqahtani, Abdulrahman
AU - Shuaibi, Ahmad
AU - Al Qarni, Ali
AU - Alkatheri, Mufareh
AU - Al Hazme, Raed H.
AU - Vishwakarma, Ramesh Kumar
AU - Aldibasi, Omar
AU - Alshahrani, Mohammed Saeed
AU - Attia, Ashraf
AU - Alharthy, Abdulrahman
AU - Mady, Ahmed
AU - Abdelrahman, Basheer Abdullah
AU - Mhawish, Huda Ahmad
AU - Abdallah, Hassan Ahmad
AU - Al-Hameed, Fahad
AU - Alghamdi, Khalid
AU - Alghamdi, Adnan
AU - Almekhlafi, Ghaleb A.
AU - Qasim, Saleh Abdorabo Haider
AU - Al Haji, Hussain Ali
AU - Al Mutairi, Mohammed
AU - Tashkandi, Nabiha
AU - Alabbasi, Shatha Othman
AU - Al Shehri, Tariq
AU - Moftah, Emad
AU - Kalantan, Basim
AU - Matroud, Amal
AU - Naidu, Brintha
AU - Al Zayer, Salha
AU - Burrows, Victoria
AU - Said, Zayneb
AU - Soomro, Naseer Ahmed
AU - Yousef, Moawea Hesham
AU - Fattouh, Ayman Abdulmonem
AU - Tahoon, Manar Aboelkhair
AU - Latif, Asad
AU - Berenholtz, Sean M.
N1 - Funding Information:
The study was financially supported by the Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We would like to thank all medical, nursing, respiratory care, physiotherapy and infection control staff in the participating ICUs.
Publisher 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.
PY - 2023/1
Y1 - 2023/1
N2 - 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.
AB - 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.
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U2 - 10.1371/journal.pone.0280744
DO - 10.1371/journal.pone.0280744
M3 - Article
C2 - 36716310
AN - SCOPUS:85147168620
SN - 1932-6203
VL - 18
JO - PloS one
JF - PloS one
IS - 1 January
M1 - e0280744
ER -