Intensive care units (ICUs) are highly complex environments where care is often delivered to the most vulnerable patients. To improve outcomes and safety in its ICUs, CKHS joined the Transformation of the Intensive Care Unit (TICU) national collaborative sponsored by VHA, Inc., an alliance of not-for-profit hospitals, health systems, and their affiliates.

The focus of the TICU collaborative is on the ventilated patient. The goal in the first year is for 85 percent of patients on mechanical ventilation to receive six important components of care—now known as the “ventilator bundle”—that have been demonstrated to decrease time on the ventilator, decrease ventilator-associated pneumonia, and increase survival.

Ventilator Associated Pneumonia (VAP) occurs in up to 15% of patients receiving mechanical ventilation. VAP is a source of morbidity and mortality in critically ill patients.

Performance Measures - The "Ventilator Bundle"

The “ventilator bundle” components are not necessarily new or high tech, but when implemented consistently, they have been shown to produce better outcomes. These include:

• Keeping the head of bed elevated a minimum of 30 degrees
• The use of peptic ulcer disease prophylaxis
• Deep vein thrombosis prophylaxis
• Daily interruption of sedative medications (to help wean the patient)
• Daily assessment of ability to wean from mechanical ventilation
• Control of blood sugar ≤110 gm/dl

Related Information

• Jacobi, Judith, PharmD, FCCM, BCPS  et al. “Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult.” Critical Care Medicine 2002 Jan;30(1):119-41.
  No Abstract
  
  
• Sessler, Cutis N. MD, FCCM. “Wake Up and Breathe.” Critical Care Medicine 2004 Jun;32(6):1413-4.
  No Abstract
  
  
• Van Nieuwenhoven, Christianne A. MD et al. “Oral Decontamination Is Cost-Saving in the Prevention of Ventilator-associated Pneumonia in Intensive Care Units.” Critical Care Medicine 2004 Jan;32(1):126-30.
  Abstract