The efficacy of VAP prophylaxis bundle

Abstract

Objective: to evaluate efficacy of VAP prophylaxis bundle. Methods: 79 ICU pts were included in RCT. The reason of invasive mechanical ventilation was the depression of consciousness due to stroke or head injury. The pts were randomized to VAP prophylaxis bundle group 1 or to standard care group 2. In first group we used bundle including filter and HME, special antimicrobial ventilator circuit, closed aspiration system and special oral hygiene system. The oral care performed 3 time per 24 hours with visual inspection, 0,05 % chlorhexidine solution washing, dental and gun cleaning, only closed system aspiration. Results: VAP prophylaxis bundle decrease early onset VAP - 6.6 and 33 % in 1 and 2 groups respectively (p = 0.00167), increase VAP free-day - 7.5 ± 4.6 day in 1 group and 5.3 ± 6.5 day, (p = 0.00182) in group 2; decrease severity of VAP - CPIS on day 7 was 5.96 ± 3.2 and 7.2 ± 2.43 in 1 and 2 groups (p = 0.046), P/F on day 7 - 304.84 ± 22 and 255.9 ± 43 in 1 and 2 groups (p = 0.001). The multivariate analysis show that oral care protocol was he most significant part of bundle (OR 0.21, 0.15-0.61 95 % CI; p = 0.00014). Microbiology data show decrease of CFU colonization Klebsiella pneumoniae from 10⁶ to 10⁴ (p < 0.001), Streptococcus pneumoniae from 10⁷ to 10³ (p < 0.001), MRSA from 10⁵ to 10³ (p < 0.001), Proteus mirabilis from 10⁷ to 10³ (p < 0.001). Conclusions: VAP prophylaxis bundle decrease “early onset” VAP, severity of VAP, increase VAP free day.