National Approach to Standardize and Improve Mechanical Ventilation

Study Overview
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Brief Summary
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This is a pre-post implementation cohort study. This is a data driven quality improvement project which aims to improve the care of mechanically ventilated patients through the implementation of a bundle of evidence based practices, with a goal of reducing ventilator associated events and mortality.

Detailed Description
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NASAM is a national collaborative quality improvement project in Saudi Arabia which aims to: Reduce the rate of ventilator-associated events Improve the compliance with NASAM bundle elements Reduce the mortality of mechanically ventilated patients The plan of this quality improvement project is to extend the implementation to a total of 100 ICUs in collaboration with multiple health systems across the country. A significant component of this project includes measuring the safety culture of ICUs.

Official Title
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National Approach to Standardize and Improve Mechanical Ventilation Care for Critically Ill Patients in Saudi Arabia

Conditions
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Mechanical Ventilation Complication

Intervention / Treatment
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* Other: Evidence-based practices


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All adult patients admitted to intensive care units Exclusion Criteria: Age less than 14 years old

Ages Eligible for Study
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Minimum Age: 14 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Mechanically Ventilated Patients<br>All patients admitted to the critical care unit and require mechanical ventilation | Other: Evidence-based practices<br>* Implementation of evidence-based practices<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ventilator-associated events | Ventilator-associated events rate per 1000 ventilator days in 18 months | 18 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sub-glottic endotracheal tube compliance rate | The percentage of ventilator days with sub-glottic endotracheal tube use | 18 months | 
| Head of bed elevation compliance rate | The percentage of ventilator days with head of bed elevation ≥30 degrees | 18 months | 
| Spontaneous awakening trial (SAT) compliance rate | The percentage of ventilator days with spontaneous awakening trial (SAT) | 18 months | 
| Percentage of ventilated patient days without sedation | The percentage of ventilated patient days without sedation use | 18 months | 
| Spontaneous breathing trials (SBT) compliance rate | The percentage of ventilator days with spontaneous breathing trial (SBT) | 18 months | 
| Percentage of ventilated patient days without neuromuscular blockers | The percentage of ventilated patient days without neuromuscular blockers | 18 months | 
| Percentage of out of bed mobility | The percentage of ventilated patient days with out of bed mobility | 18 months | 
| Percentage of CAM-ICU negative (no delirium) | The percentage of ventilator days with CAM-ICU negative (no delirium) | 18 months | 
| 90-day mortality | The 90-day ICU mortality rate of ventilated patients | 90 days | 
| Mechanical ventilation duration | The duration of mechanical ventilation in calendar days | 90 days | 
| ICU length of stay | The number of calendar days from ICU admission to discharge from ICU | 90 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Ventilator-associated pneumonia, Mechanical Ventilation, Ventilator-associated events, Intensive care unit, Quality improvement project