presented by Kathleen Vollman
More than a quarter of a million patients in the United States receive mechanical ventilation each year, putting them at risk for increased mortality related to pneumonia and acute respiratory distress syndrome, among other lung injuries. How can we prevent these ventilator-associated events (VAE)? Pain/sedation/delirium management, oral care, ventilator setting, early removal of the ventilator, and progressive mobility have all been shown to have a significant impact on outcomes of patients receiving mechanical ventilation. This course will explore the evidence around implementation of the ABCDEF bundle to reduce both short- and long-term negative consequences of mechanical ventilation and the ICU. This course content is applicable to nurses and other health care professionals who work with patients in acute care, rehabilitation, and long-term care settings.
Kathleen Vollman is a Critical Care Clinical Nurse Specialist, Educator, and Consultant. She has published and lectured nationally and internationally on a variety of topics, including pulmonary care, critical care, prevention of health-care-acquired injuries, work culture, and sepsis recognition and management. From 1989 to 2003, she functioned in the role of Clinical Nurse Specialist for the Medical ICUs at Henry Ford Hospital in Detroit Michigan. Currently her company, ADVANCING NURSING LLC, is focused on creating empowered work environments for nurses through the acquisition of greater skills and knowledge. Ms. Vollman is a subject matter expert for prevention of CAUTI, CLABSI, and HAPI as well as sepsis recognition/management and the culture of safety for HRET and the Michigan Hospital Association. In 2004, Kathleen was inducted into the College of Critical Care Medicine; in 2009, she was inducted into the American Academy of Nurses. In 2012, Ms. Vollman was appointed to serve as an honorary ambassador to the World Federation of Critical Care Nurses.
In order to establish more objective surveillance criteria, the CDC transitioned from ventilator-associated pneumonia to ventilator-associated events (VAE) in adult acute care hospitals and in long-term care hospitals. VAE surveillance detects a broader range of conditions. In this chapter, the three types of VAEs are discussed.
A large number of patients who were on mechanical ventilation in the ICU experience physical disabilities, challenges in cognitive function, and mental health issues. Twenty to eighty percent of ICU patients have delirium during their time in the ICU. This contributes to cognitive impairment as well as depression and PTSD that can persist for years. This chapter explores the long-term effects of mechanical ventilation and ICU if the correct prevention strategies are not put in place.
The original ventilator bundle was created in the early 2000s to help prevent injury associated with being on a mechanical ventilator. In this chapter, the prevention strategies to reduce risk of aspiration, stress ulcers, and deep vein thrombosis are discussed. The next two chapters will outline the evolution of a larger bundle that improves overall care of the ICU mechanically ventilated patient.
The ABCDEF bundle extends the original VAP bundle and was developed to improve the health of ventilated patients by reducing the risk of oversedation and immobility, improving patient comfort, reducing the risk of infection, and decreasing the risk of mental status changes and long-term morbidity. In this chapter, we will discuss the ABC portion of the ABCDEF bundle: Assess and manage pain, Both spontaneous awakening trial and spontaneous breathing trial, and Choice of sedation.
The ABCDEF bundle extends the original VAP bundle. In this chapter, we will discuss the DEF portion of the ABCDEF bundle, which helps the clinician assess and manage delirium and implement an early progressive mobility program while engaging the patient and family in the journey.