The utility of the best care always bundle for the prevention of ventilator associated pneumonia in patients with severe traumatic brain injury
Thesis / Dissertation
2023
Permanent link to this Item
Authors
Supervisors
Journal Title
Link to Journal
Journal ISSN
Volume Title
Publisher
Publisher
University of Cape Town
Department
Faculty
License
Series
Abstract
Introduction Severe traumatic brain injury (STBI) is a risk factor for ventilator-associated pneumonia (VAP). In STBI, VAP is associated with worse neurological outcomes. Aim Quantify the impact of the “Best Care Always Bundle” (BCAB) on VAP-rate in STBI patients. Methods Retrospective review of STBI patients 12-months before (cohort 1) and after (cohort 2) implementation of the VAP-BCAB. Primary outcome: VAP incidence after implementation of BCAB. Secondary outcomes: duration of mechanical ventilation (MV), Neurocritical care unit (NCCU) and hospital length of stay (LoS), mortality, tracheostomy rate, re-intubation rate, and antibiotic use. Adherence to VAP-BCAB and correlation with VAP-rate was also analysed. Results Incidence of VAP were 24,7% and 18,6% in cohort 1 and 2 respectively (p=0.163). Duration of MV 6,7 days (5,4-7,9) and 7,3 days (6,1-8,4) in cohort 1 and 2 respectively (p=0.520). NCCU LoS 10,7 days (8,9-12,4) and 10,4 days (8,9-11,8) in cohort 1 and 2 respectively (p=0.797). Hospital LoS 21,5 days (16,2-26,9) and 18,0 days (15,3-20,6) in cohort 1 and 2 respectively (p=0.246). Thirty tracheostomies (37,5%) were recorded in cohort 1, 33 (31,7%) in cohort 2 (p=0.219). Thirteen re-intubations (20%) were recorded in cohort 1, nine (10,2%) in cohort 2 (p=0.055). Patients with VAP were fewer (7%) in months with high adherence to the VAP-BCAB, compared to low adherence months (28%) (p=0.003). Conclusion The clinical utility of the VAP-BCAB for the prevention of VAPs in STBI patients was clear in this study but the significance could only be shown where adherence to the VAP-BCAB was high.
Description
Keywords
Reference:
Kruger, A. 2023. The utility of the best care always bundle for the prevention of ventilator associated pneumonia in patients with severe traumatic brain injury. . University of Cape Town ,Faculty of Health Sciences ,Division of General Surgery. http://hdl.handle.net/11427/43125