PLoS ONE (Jan 2023)

Impact of a national collaborative project to improve the care of mechanically ventilated patients

  • Yaseen M. Arabi,
  • Zohair Al Aseri,
  • Abdulmohsen Alsaawi,
  • Ali M. Al Khathaami,
  • Eman Al Qasim,
  • Abdullah A. Alzahrani,
  • Mohammed Al Qarni,
  • Sheryl Ann I. Abdukahil,
  • Hasan M. Al-Dorzi,
  • Abdulaleem Alattasi,
  • Yasser Mandourah,
  • Tareef Y. Alaama,
  • Mohammed K. Alabdulaali,
  • Abdulrahman Alqahtani,
  • Ahmad Shuaibi,
  • Ali Al Qarni,
  • Mufareh Alkatheri,
  • Raed H. Al Hazme,
  • Ramesh Kumar Vishwakarma,
  • Omar Aldibasi,
  • Mohammed Saeed Alshahrani,
  • Ashraf Attia,
  • Abdulrahman Alharthy,
  • Ahmed Mady,
  • Basheer Abdullah Abdelrahman,
  • Huda Ahmad Mhawish,
  • Hassan Ahmad Abdallah,
  • Fahad Al-Hameed,
  • Khalid Alghamdi,
  • Adnan Alghamdi,
  • Ghaleb A. Almekhlafi,
  • Saleh Abdorabo Haider Qasim,
  • Hussain Ali Al Haji,
  • Mohammed Al Mutairi,
  • Nabiha Tashkandi,
  • Shatha Othman Alabbasi,
  • Tariq Al Shehri,
  • Emad Moftah,
  • Basim Kalantan,
  • Amal Matroud,
  • Brintha Naidu,
  • Salha Al Zayer,
  • Victoria Burrows,
  • Zayneb Said,
  • Naseer Ahmed Soomro,
  • Moawea Hesham Yousef,
  • Ayman Abdulmonem Fattouh,
  • Manar Aboelkhair Tahoon,
  • Majdi Muhammad,
  • Afifah Muslim Alruwili,
  • Hossam Ahmed Al Hanafi,
  • Pramodini B. Dandekar,
  • Kamel Ibrahim,
  • Mwafaq AlHomsi,
  • Asma Rayan Al Harbi,
  • Adel Saleem,
  • Ejaz Masih,
  • Nowayer Monawer Al Rashidi,
  • Aslam Khan Amanatullah,
  • Jaffar Al Mubarak,
  • Amro Ali Abduljalil Al Radwan,
  • Ali Al Hassan,
  • Sadiyah Al Muoalad,
  • Ammar Abdullah Alzahrani,
  • Jamal Chalabi,
  • Ahmad Qureshi,
  • Maryam Al Ansari,
  • Hend Sallam,
  • Alyaa Elhazmi,
  • Fawziah Alkhaldi,
  • Abdulrauf Malibary,
  • Abdullah Ababtain,
  • Asad Latif,
  • Sean M. Berenholtz

Journal volume & issue
Vol. 18, no. 1

Abstract

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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. Registration The study is registered in clinicaltrials.gov (NCT03790150).