The utility of the best care always bundle for the prevention of ventilator associated pneumonia in patients with severe traumatic brain injury
| dc.contributor.advisor | Semple, Patrick | |
| dc.contributor.author | Kruger, Andries | |
| dc.date.accessioned | 2026-04-23T09:27:52Z | |
| dc.date.available | 2026-04-23T09:27:52Z | |
| dc.date.issued | 2023 | |
| dc.date.updated | 2026-04-23T07:47:06Z | |
| dc.description.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. | |
| dc.identifier.apacitation | Kruger, A. (2023). <i>The utility of the best care always bundle for the prevention of ventilator associated pneumonia in patients with severe traumatic brain injury</i>. (). University of Cape Town ,Faculty of Health Sciences ,Division of General Surgery. Retrieved from http://hdl.handle.net/11427/43125 | en_ZA |
| dc.identifier.chicagocitation | Kruger, Andries. <i>"The utility of the best care always bundle for the prevention of ventilator associated pneumonia in patients with severe traumatic brain injury."</i> ., University of Cape Town ,Faculty of Health Sciences ,Division of General Surgery, 2023. http://hdl.handle.net/11427/43125 | en_ZA |
| dc.identifier.citation | 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 | en_ZA |
| dc.identifier.ris | TY - Thesis / Dissertation AU - Kruger, Andries AB - 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. DA - 2023 DB - OpenUCT DP - University of Cape Town KW - General Surgery LK - https://open.uct.ac.za PB - University of Cape Town PY - 2023 T1 - The utility of the best care always bundle for the prevention of ventilator associated pneumonia in patients with severe traumatic brain injury TI - The utility of the best care always bundle for the prevention of ventilator associated pneumonia in patients with severe traumatic brain injury UR - http://hdl.handle.net/11427/43125 ER - | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11427/43125 | |
| dc.identifier.vancouvercitation | Kruger A. 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, 2023 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/43125 | en_ZA |
| dc.language.rfc3066 | eng | |
| dc.publisher.department | Division of General Surgery | |
| dc.publisher.faculty | Faculty of Health Sciences | |
| dc.publisher.institution | University of Cape Town | |
| dc.subject | General Surgery | |
| dc.title | The utility of the best care always bundle for the prevention of ventilator associated pneumonia in patients with severe traumatic brain injury | |
| dc.type | Thesis / Dissertation | |
| dc.type.qualificationlevel | Masters | |
| dc.type.qualificationlevel | Masters |