by Pileggi, Claudia;
Mascaro, Valentina; Bianco, Aida; Nobile, Carmelo G. A.; Pavia, Maria
Objectives: To assess
the effectiveness of the ventilator bundle in the reduction of mortality in ICU
patients. Data Sources: PubMed, Scopus, Web of Science, Cochrane Library for
studies published until June 2017. Study Selection: Included studies:
randomized controlled trials or any kind of nonrandomized intervention studies,
made reference to a ventilator bundle approach, assessed mortality in ICU-ventilated
adult patients. Data Extraction: Items extracted: study characteristics,
description of the bundle approach, number of patients in the comparison
groups, hospital/ICU mortality, ventilator-associated pneumonia–related
mortality, assessment of compliance to ventilator bundle and its score. Data
Synthesis: Thirteen articles were included. The implementation of a ventilator
bundle significantly reduced mortality (odds ratio, 0.90; 95% CI, 0.84–0.97),
with a stronger effect with a restriction to studies that reported mortality in
ventilator-associated pneumonia patients (odds ratio, 0.71; 95% CI, 0.52–0.97),
to studies that provided active educational activities was analyzed (odds
ratio, 0.88; 95% CI, 0.78–0.99), and when the role of care procedures within
the bundle (odds ratio, 0.87; 95% CI, 0.77–0.99). No survival benefit was
associated with compliance to ventilator bundles. However, these results may
have been confounded by the differential implementation of evidence-based
procedures at baseline, which showed improved survival in the study subgroup
that did not report implementation of these procedures at baseline (odds ratio,
0.82; 95% CI, 0.70–0.96). Conclusions: Simple interventions in common clinical
practice applied in a coordinated way as a part of a bundle care are effective
in reducing mortality in ventilated ICU patients. More prospective controlled
studies are needed to define the effect of ventilator bundles on survival
outcomes.
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