Six simple interventions have been demonstrated to improve outcomes in mechanical ventilation: daily interruptions in sedation, stress ulcer prophylaxis, DVT prophylaxis, elevation of the head of the bed, aggressive glycemic control and spontaneous breathing trials. The first four of these comprise the ventilator bundle. But as basic as they seem their rate of implementation is variable across clinical settings and low overall.
In this report from the American Journal of Medical Quality cases involving mechanical ventilation were reviewed from 38 academic medical centers. Compliance with the six practices was determined and a logistic regression model was used to estimate the effect of each measure on mortality. Compliance rates varied among institutions and were poor in general. Of the six measures, sedation interruption and glycemic control were associated with reductions in mortality.
This is all about the elusive goal of putting evidence into practice. The authors discuss barriers and potential solutions.