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Ventilator Bundle and Its Effects on Mortality Among ICU Patients

A Meta-Analysis*

Pileggi, Claudia, MD1; Mascaro, Valentina, MD1; Bianco, Aida, MD1; Nobile, Carmelo G. A., MD2,3; Pavia, Maria, MD, MPH1

doi: 10.1097/CCM.0000000000003136
Review Articles

Objectives: To assess the effectiveness of the ventilator bundle in the reduction of mortality in ICU patients.

Data Sources: PubMed, Scopus, Web of Science, Cochrane Library for studies published until June 2017.

Study Selection: Included studies: randomized controlled trials or any kind of nonrandomized intervention studies, made reference to a ventilator bundle approach, assessed mortality in ICU-ventilated adult patients.

Data Extraction: Items extracted: study characteristics, description of the bundle approach, number of patients in the comparison groups, hospital/ICU mortality, ventilator-associated pneumonia–related mortality, assessment of compliance to ventilator bundle and its score.

Data Synthesis: Thirteen articles were included. The implementation of a ventilator bundle significantly reduced mortality (odds ratio, 0.90; 95% CI, 0.84–0.97), with a stronger effect with a restriction to studies that reported mortality in ventilator-associated pneumonia patients (odds ratio, 0.71; 95% CI, 0.52–0.97), to studies that provided active educational activities was analyzed (odds ratio, 0.88; 95% CI, 0.78–0.99), and when the role of care procedures within the bundle (odds ratio, 0.87; 95% CI, 0.77–0.99). No survival benefit was associated with compliance to ventilator bundles. However, these results may have been confounded by the differential implementation of evidence-based procedures at baseline, which showed improved survival in the study subgroup that did not report implementation of these procedures at baseline (odds ratio, 0.82; 95% CI, 0.70–0.96).

Conclusions: Simple interventions in common clinical practice applied in a coordinated way as a part of a bundle care are effective in reducing mortality in ventilated ICU patients. More prospective controlled studies are needed to define the effect of ventilator bundles on survival outcomes.

1Department of Health Sciences, University of Catanzaro “Magna Gracia,” Catanzaro, Italy.

2Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Cosenza, Italy.

3Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy.

*See also p. 1201.

Drs. Pileggi and Pavia conceived and designed the study. Drs. Pileggi, Mascaro, and Nobile did the literature review and data collection. Drs. Mascaro and Bianco did the statistical analysis. Drs. Pileggi and Pavia wrote the article. All authors contributed to the interpretation of the data and writing of the article and agree with its content and conclusions.

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The authors have disclosed that they do not have any potential conflicts of interest.

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