Improving Care for Mechanically Ventilated Patients
Patients on mechanical ventilation are an extremely vulnerable subset of the intensive care unit population. While the short-term risks — such as ventilator-associated pneumonia and pulmonary embolism — are well established, the long-term risks of being on a ventilator have come into focus in recent years. Patients may experience physical disabilities, lingering cognitive dysfunction and psychiatric issues such as anxiety and depression, for months or years after their hospitalizations.
Through a contract awarded in September 2013 by the Agency for Healthcare Research and Quality, the Armstrong Institute led a three-year national collaborative project that aimed to prevent these short- and long-term harms, while reducing length of stay and readmissions. Improving care of patients on mechanical ventilation can save patients’ lives, prevent suffering and reduce health care costs.
One product of the project is the Toolkit to Improve Safety of Mechanically Ventilated Patients, hosted on the AHRQ website. Hospitals can adapt the guides, tools, and educational slide sets in this toolkit to improve the care of patients on breathing machines.
- Reduce ICU inpatient mortality
- Prevent short-term complications, such as ventilator-associated pneumonia and sepsis
- Reduce long-term physical, cognitive and psychological harm to ICU survivors
- Decrease the number of mechanical ventilation days and overall length of stay
- Improve hospital and ICU efficiency by increasing patient throughput
- Enhance teamwork and communication
Why Target Mechanical Ventilation?
- 800,000 patients receive mechanical ventilation in the U.S. each year
- 35 percent mortality rate
- 10–20 percent of ventilated patients develop ventilator-associated pneumonia, perhaps the most deadly hospital-acquired infection
- 40.5 percent of mechanical ventilation lasts 8 days or longer
- Ventilator-associated events, such as pneumonia and acute respiratory distress, are associated with longer ventilator days, hospital stays, and higher mortality rates compared to patients without these events
“Our ventilator-associated event rate went from 16.04 per 1,000 vent days in May 2014 to 5.43 in April 2015. I believe that getting ICU patients walking and decreasing their sedation is the biggest thing that’s going to help their outcomes.”
- Kassie Basnight, R.N., B.S.N., Nurse Manager, Tampa General Hospital