Impact of a national collaborative project to improve the care of mechanically ventilated patients

Yaseen M Arabi; Zohair Al Aseri; Abdulmohsen Alsaawi; Ali M Al Khathaami; Eman Al Qasim; Abdullah A Alzahrani; Mohammed Al Qarni; Sheryl Ann I Abdukahil; Hasan M Al-Dorzi; Abdulaleem Alattasi; Yasser Mandourah; Tareef Y Alaama; Mohammed K Alabdulaali; Abdulrahman Alqahtani; Ahmad Shuaibi; Ali Al Qarni; Mufareh Alkatheri; Raed H Al Hazme; Ramesh Kumar Vishwakarma; Omar Aldibasi; Mohammed Saeed Alshahrani; Ashraf Attia; Abdulrahman Alharthy; Ahmed Mady; Basheer Abdullah Abdelrahman; Huda Ahmad Mhawish; Hassan Ahmad Abdallah; Fahad Al-Hameed; Khalid Alghamdi; Adnan Alghamdi; Ghaleb A Almekhlafi; Saleh Abdorabo Haider Qasim; Hussain Ali Al Haji; Mohammed Al Mutairi; Nabiha Tashkandi; Shatha Othman Alabbasi; Tariq Al Shehri; Emad Moftah; Basim Kalantan; Amal Matroud; Brintha Naidu; Salha Al Zayer; Victoria Burrows; Zayneb Said; Naseer Ahmed Soomro; Moawea Hesham Yousef; Ayman Abdulmonem Fattouh; Manar Aboelkhair Tahoon; Majdi Muhammad; Afifah Muslim Alruwili; Hossam Ahmed Al Hanafi; Pramodini B Dandekar; Kamel Ibrahim; Mwafaq AlHomsi; Asma Rayan Al Harbi; Adel Saleem; Ejaz Masih; Nowayer Monawer Al Rashidi; Aslam Khan Amanatullah; Jaffar Al Mubarak; Amro Ali Abduljalil Al Radwan; Ali Al Hassan; Sadiyah Al Muoalad; Ammar Abdullah Alzahrani; Jamal Chalabi; Ahmad Qureshi; Maryam Al Ansari; Hend Sallam; Alyaa Elhazmi; Fawziah Alkhaldi; Abdulrauf Malibary; Abdullah Ababtain; Asad Latif; Sean M Berenholtz; Saudi Critical Care Trials Group

doi:10.1371/journal.pone.0280744

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Impact of a national collaborative project to improve the care of mechanically ventilated patients

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Impact of a national collaborative project to improve the care of mechanically ventilated patients

Yaseen M Arabi, Zohair Al Aseri, Abdulmohsen Alsaawi, Ali M Al Khathaami, Eman Al Qasim, Abdullah A Alzahrani, Mohammed Al Qarni, Sheryl Ann I Abdukahil, Hasan M Al-Dorzi, Abdulaleem Alattasi, …

PloS one, Vol.18(1), pp.e0280744-e0280744

30/01/2023

DOI: https://doi.org/10.1371/journal.pone.0280744

PMID: 36716310

Abstract

Humans

Intensive Care Units

Prospective Studies

Respiration, Artificial - methods

Ventilator Weaning - methods

Ventilators, Mechanical

This prospective quasi-experimental study from the NASAM (National Approach to Standardize and Improve Mechanical Ventilation) collaborative assessed the impact of evidence-based practices including subglottic suctioning, daily assessment for spontaneous awakening trial (SAT), spontaneous breathing trial (SBT), head of bed elevation, and avoidance of neuromuscular blockers unless otherwise indicated. The study outcomes included VAE (primary) and intensive care unit (ICU) mortality. Changes in daily care process measures and outcomes were evaluated using repeated measures mixed modeling. The results were reported as incident rate ratio (IRR) for each additional month with 95% confidence interval (CI). A comprehensive program that included education on evidence-based practices for optimal care of mechanically ventilated patients with real-time benchmarking of daily care process measures to drive improvement in forty-two ICUs from 26 hospitals in Saudi Arabia (>27,000 days of observation). Compliance with subglottic suctioning, SAT and SBT increased monthly during the project by 3.5%, 2.1% and 1.9%, respectively (IRR 1.035, 95%CI 1.007-1.064, p = 0.0148; 1.021, 95% CI 1.010-1.032, p = 0.0003; and 1.019, 95%CI 1.009-1.029, p = 0.0001, respectively). The use of neuromuscular blockers decreased monthly by 2.5% (IRR 0.975, 95%CI 0.953-0.998, p = 0.0341). The compliance with head of bed elevation was high at baseline and did not change over time. Based on data for 83153 ventilator days, VAE rate was 15.2/1000 ventilator day (95%CI 12.6-18.1) at baseline and did not change during the project (IRR 1.019, 95%CI 0.985-1.053, p = 0.2812). Based on data for 8523 patients; the mortality was 30.4% (95%CI 27.4-33.6) at baseline, and decreased monthly during the project by 1.6% (IRR 0.984, 95%CI 0.973-0.996, p = 0.0067). A national quality improvement collaborative was associated with improvements in daily care processes. These changes were associated with a reduction in mortality but not VAEs. Registration The study is registered in clinicaltrials.gov (NCT03790150).

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Title: Impact of a national collaborative project to improve the care of mechanically ventilated patients
Creators - without role: Yaseen M Arabi - King Saud bin Abdulaziz University for Health Sciences
Zohair Al Aseri - King Saud University
Abdulmohsen Alsaawi - King Saud bin Abdulaziz University for Health Sciences
Ali M Al Khathaami - King Saud bin Abdulaziz University for Health Sciences
Eman Al Qasim - King Saud bin Abdulaziz University for Health Sciences
Abdullah A Alzahrani - King Saud bin Abdulaziz University for Health Sciences
Mohammed Al Qarni - King Saud bin Abdulaziz University for Health Sciences
Sheryl Ann I Abdukahil - King Saud bin Abdulaziz University for Health Sciences
Hasan M Al-Dorzi - King Saud bin Abdulaziz University for Health Sciences
Abdulaleem Alattasi - King Saud bin Abdulaziz University for Health Sciences
Yasser Mandourah - Riyadh Armed Forces Hospital
Tareef Y Alaama - Deputyship of Curative Services, Ministry of Health, Riyadh, Saudi Arabia
Mohammed K Alabdulaali - Ministry of Health
Abdulrahman Alqahtani - King Saud Medical City
Ahmad Shuaibi - King Saud bin Abdulaziz University for Health Sciences
Ali Al Qarni - King Saud bin Abdulaziz University for Health Sciences
Mufareh Alkatheri - King Saud bin Abdulaziz University for Health Sciences
Raed H Al Hazme - King Saud bin Abdulaziz University for Health Sciences
Ramesh Kumar Vishwakarma - European Organisation for Research and Treatment of Cancer
Omar Aldibasi - King Saud bin Abdulaziz University for Health Sciences
Mohammed Saeed Alshahrani - Imam Abdulrahman Bin Faisal University
Ashraf Attia - Imam Abdulrahman Bin Faisal University
Abdulrahman Alharthy - King Saud Medical City
Ahmed Mady - King Saud Medical City
Basheer Abdullah Abdelrahman - King Saud Medical City
Huda Ahmad Mhawish - King Saud Medical City
Hassan Ahmad Abdallah - King Saud Medical City
Fahad Al-Hameed - King Saud bin Abdulaziz University for Health Sciences
Khalid Alghamdi - King Faisal Specialist Hospital & Research Centre
Adnan Alghamdi - Riyadh Armed Forces Hospital
Ghaleb A Almekhlafi - Riyadh Armed Forces Hospital
Saleh Abdorabo Haider Qasim - King Saud bin Abdulaziz University for Health Sciences
Hussain Ali Al Haji - King Saud bin Abdulaziz University for Health Sciences
Mohammed Al Mutairi - National Guard Health Affairs
Nabiha Tashkandi - King Saud bin Abdulaziz University for Health Sciences
Shatha Othman Alabbasi - King Saud bin Abdulaziz University for Health Sciences
Tariq Al Shehri - King Saud bin Abdulaziz University for Health Sciences
Emad Moftah - King Saud bin Abdulaziz University for Health Sciences
Basim Kalantan - King Saud bin Abdulaziz University for Health Sciences
Amal Matroud - King Saud bin Abdulaziz University for Health Sciences
Brintha Naidu - King Saud bin Abdulaziz University for Health Sciences
Salha Al Zayer - King Saud bin Abdulaziz University for Health Sciences
Victoria Burrows - King Saud bin Abdulaziz University for Health Sciences
Zayneb Said - King Saud bin Abdulaziz University for Health Sciences
Naseer Ahmed Soomro - Department of Intensive Care, Arar Central Hospital, Arar, Saudi Arabia
Moawea Hesham Yousef - Department of Intensive Care, Alrass General Hospital, AlQassim, Saudi Arabia
Ayman Abdulmonem Fattouh - King Fahad Hospital Jeddah
Manar Aboelkhair Tahoon - King Abdulaziz Hospital
Majdi Muhammad - Department of Intensive Care, Gurayat General Hospital, AlGurayat, Saudi Arabia
Afifah Muslim Alruwili - Prince Mohammed bin Abdulaziz Hospital
Hossam Ahmed Al Hanafi - Department of Intensive Care, King Salman Hospital, Riyadh, Saudi Arabia
Pramodini B Dandekar - King Abdullah Medical City
Kamel Ibrahim - King Khaled Hospital
Mwafaq AlHomsi - Buraydah Colleges
Asma Rayan Al Harbi - King Fahad Specialist Hospital
Adel Saleem - Imam Abdulrahman Al Faisal Hospital
Ejaz Masih - King Khaled Hospital
Nowayer Monawer Al Rashidi - King Khaled Hospital
Aslam Khan Amanatullah - King Khaled Hospital
Jaffar Al Mubarak - Northern Area Armed Forces Hospital
Amro Ali Abduljalil Al Radwan - Jubail Industrial College
Ali Al Hassan - King Khaled Hospital
Sadiyah Al Muoalad - King Saud bin Abdulaziz University for Health Sciences
Ammar Abdullah Alzahrani - King Saud bin Abdulaziz University for Health Sciences
Jamal Chalabi - King Saud bin Abdulaziz University for Health Sciences
Ahmad Qureshi - King Saud bin Abdulaziz University for Health Sciences
Maryam Al Ansari - King Saud bin Abdulaziz University for Health Sciences
Hend Sallam - King Faisal Specialist Hospital & Research Centre
Alyaa Elhazmi - King Faisal Specialist Hospital & Research Centre
Fawziah Alkhaldi - King Faisal Specialist Hospital & Research Centre
Abdulrauf Malibary - Riyadh Armed Forces Hospital
Abdullah Ababtain - Royal Commission Medical Center
Asad Latif - Johns Hopkins Medicine
Sean M Berenholtz - Johns Hopkins Medicine
Saudi Critical Care Trials Group
Publication Details: PloS one, Vol.18(1), pp.e0280744-e0280744
Identifiers: 9911477508331
Academic Unit: Taif University; King Abdulaziz University; King Saud University; Imam Abdulrahman Bin Faisal University; Alfaisal University; Dar Al Uloom University; King Saud Bin Abdulaziz University for Health Sciences
Language: English
Resource Type: Journal article