The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Room 704B, 7/F Esther Lee Building, Hong Kong SAR, PR China.
Department of Orthopedics, Patan Academy of Health Sciences, Lalitpur, Nepal.
Heart Lung. 2024 Jan-Feb;63:98-107. doi: 10.1016/j.hrtlng.2023.10.002. Epub 2023 Oct 13.
Ventilator bundles are suggested to prevent ventilator-associated pneumonia (VAP), but significant variations in the effects of the bundle on patient outcomes have been reported.
To synthesize the evidence and evaluate the effects of the ventilator bundle on patient outcomes among critically ill adult patients.
A broad search was performed in seven databases for relevant articles published from January 2002 to November 2022. Randomized controlled trials and quasi-experimental studies investigating the effects of implementing ventilator bundles in adult intensive care units (ICUs) were included. Two independent reviewers performed the study selection, data extraction, and risk of bias assessment. All data for meta-analysis were pooled using the random-effects model.
After screening, 19 studies were included in the meta-analysis. Evidence of low-to-moderate certainty showed that the ventilator bundle reduced the rate of VAP (risk ratio [RR] = 0.64; P = 0.003), length of ICU stay (mean difference [MD] = -2.57; P = 0.03), mechanical ventilation days (MD = -3.38; P < 0.001), and ICU mortality (RR = 0.76; P = 0.02). Ventilator bundle was associated with improved outcomes, except mortality.
The ventilator bundle, especially the IHI ventilator bundle, was effective in decreasing the incidence of VAP and improving most of the VAP-related outcomes. However, given the low-to-moderate certainty of evidence and high heterogeneity, these results should be interpreted with caution. A future study that adopts hybrid implementation trials with high methodological quality is needed to confirm the effects of the ventilator bundle on patient outcomes.
通气机相关集束干预被认为可预防呼吸机相关性肺炎（VAP），但集束干预对患者结局的影响存在显著差异。
系统评价通气机相关集束干预对成年危重症患者结局的影响。
广泛检索 7 个数据库，收集 2002 年 1 月至 2022 年 11 月发表的关于成年 ICU 患者实施通气机相关集束干预的随机对照试验和准实验研究。由 2 名评价员独立进行文献筛选、数据提取和偏倚风险评估，采用随机效应模型进行荟萃分析。
共纳入 19 项研究，Meta 分析结果显示，通气机相关集束干预可降低 VAP 发生率（风险比 RR=0.64，P=0.003）、ICU 入住时间（均数差 MD=-2.57，P=0.03）、机械通气时间（MD=-3.38，P<0.001）和 ICU 病死率（RR=0.76，P=0.02），但对病死率的影响不显著。
通气机相关集束干预，尤其是美国医疗机构联合评审委员会/美国疾病预防控制中心（IHE/CDC）通气机相关集束干预，可降低 VAP 发生率，并改善大多数与 VAP 相关的结局，但由于证据质量为低到中等，且异质性较高，这些结果应谨慎解读。未来需要开展采用混合实施策略且方法学质量较高的研究，以进一步明确通气机相关集束干预对患者结局的影响。
