Implementation of a Revised Montpellier Bundle on the Outcome of Intubation in Critically Ill Patients: A Quality Improvement Project.
Introduction: The feasibility of implementing a revised Montpellier intubation bundle incorporating recent evidences was tested in a quality-improvement project. It was hypothesized that this "Care Bundle" implementation would reduce intubation-related complications. Materials and methods: The proje...
| Publicado en: | Indian Journal of Critical Care Medicine Vol. 26; no. 10; pp. 1106 - 1115 |
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| Autores principales: | , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Jaypee Brothers Medical Publishers Private Limited
Oct2022
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=161370160&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 161370160 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09725229 SV5 jtl: Indian Journal of Critical Care Medicine issn: 09725229 maglogo: N pubinfo: dt: Oct2022 vid: 26 iid: 10 pid: 50372 pub: Jaypee Brothers Medical Publishers Private Limited artinfo: ui: 161370160 161370160 161370160 10.5005/jp-journals-10071-24332 161370160 ppf: 1106 ppct: 9 formats: tig: atl: Implementation of a Revised Montpellier Bundle on the Outcome of Intubation in Critically Ill Patients: A Quality Improvement Project. aug: au: Ghosh, Supradip Salhotra, Ripenmeet Arora, Garima Lyall, Aditya Singh, Amandeep Kumar, Niranjan Chawla, Aayush Gupta, Meenakshi affil: Department of Critical Care Medicine, Fortis Escorts Hospital, Faridabad, Haryana, India sug: subj: Quality Improvement Intubation, Intratracheal Adverse Effects Implementation Science Critically Ill Patients Medical Practice, Evidence-Based Treatment Outcomes Human Intensive Care Units Positive Pressure Ventilation Respiration, Artificial Patient Safety India Audit APACHE (Acute Physiology and Chronic Health Evaluation) Health Status Indicators Hospital Mortality Critical Illness Mortality Chi Square Test Mann-Whitney U Test Fisher's Exact Test Data Analysis Software Middle Age Aged Male Female Descriptive Statistics Length of Stay Professional Compliance Oxygenation Fluid Resuscitation Succinylcholine Therapeutic Use Apnea Therapy Hypotension Prevention and Control Middle Aged: 45-64 years Aged: 65+ years Male Female ab: Introduction: The feasibility of implementing a revised Montpellier intubation bundle incorporating recent evidences was tested in a quality-improvement project. It was hypothesized that this "Care Bundle" implementation would reduce intubation-related complications. Materials and methods: The project was conducted in an 18-bedded multidisciplinary intensive care unit (ICU). Baseline data for intubations were collected over 3-month "Control Period". During the 2-month "Interphase", a revised intubation bundle was developed, and staff members involved in the intubation process were extensively trained on different aspects of intubation with emphasis on bundle components. Various components of the bundle were pre-intubation fluid loading, pre-oxygenation with NIV plus PS, positive-pressure ventilation post-induction, succinylcholine as a first-line induction agent, routine use of stylet, and lung recruitment within 2 minutes of intubation. Intubation data were collected again in the 3-month "Intervention Period". Results: Data were collected for 61 and 64 intubations, respectively, during control and intervention periods. There was significant improvement in compliance to five of six-bundle components; improvement in pre-intubation fluid loading during the intervention period did not reach statistical significance. Overall, at least 3 components of the bundle were compiled within over 92% of intubations in the intervention period. However, whole-bundle compliance was limited to 14.3%. Incidences of major complications were reduced significantly in the intervention period (23.8% vs 45.9%, p = 0.01). There was significant reduction in profound hypotension (21.77% vs 29.51%, p = 0.04) and a nonsignificant 11.89% reduction in profound hypoxemia. There were no differences in minor complications. Conclusion: Implementation of an evidence-based revised Montpellier intubation bundle is feasible and it reduces major complications related to endotracheal intubation. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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