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Objective: We have previously shown that intra-hospital transport is an independent risk factor for Ventilator Associated Pneumonia (VAP) in critically ill surgical patients. The purpose of this study was to determine the impact of a transport bundle and checklist (TB/CL) on high VAP rates in Neuro-trauma ICU (NT-ICU) patients.
Design: Before-after trial of implementation of a TB/CL. Prospectively collected data 3 months before and 3 months after implementation was retrospectively analyzed.
Setting: 18-bed Neuro-trauma critical care unit in a tertiary referral level 1 trauma center averaging over 190 intra-hospital transport events per month.
Patients: Patients requiring mechanical ventilation in the NT-ICU.
Intervention: Implementation of a TB/CL aimed at reducing aspiration during intra-hospital transport. The following elements were included: elevation of head-of-bed 45° if no contraindication, use of a ventilator during transport, portable suction applied to gastric tubes and to the sub-glottic suctioning port of the endotracheal tube (ETT), cessation of enteric feeds and verification of ETT cuff pressure at 25-30 cm H₂0. A checklist was completed before leaving the NT-ICU and then before leaving the transport destination to return to the NT-ICU. Use of a VAP bundle was standard of care before and after the intervention.
Main Outcome Measures: VAP rates as determined by NNISS criteria.
Results: After implementation, VAP rates decreased from 10.9/1000 ventilator days to 3.8/1000 ventilator days; a 65% reduction. The number of intra-hospital transport events was similar before and after implementation (606 vs. 654).
Conclusions: Implementation of a transport bundle/checklist significantly reduced the rate of VAP in NT-ICU patients. Elevated VAP rates despite use of standard VAP bundle may be necessary in ICU’s with high frequency intra-hospital transport events.