A European care bundle for management of ventilator-associated pneumonia.
BACKGROUND
Although there is a wealth of guidance concerning the management of patients with ventilator-associated pneumonia (VAP), compliance with recommendations concerning optimal treatment practices is highly variable.


METHODS
This document presents a comprehensive care bundle package addressing all aspects of VAP diagnosis and treatment in an attempt to promote guideline-compliant practices. Uniquely, the development of these care bundles used a formalized method to assess the supporting data, based on multicriteria decision analysis.


RESULTS
This system allowed the numerous VAP management parameters identified from recent European guidelines to be ranked according to defined criteria. The resulting VAP care bundles are (a) diagnosis: early chest x-rays within 1 hour, immediate reporting of respiratory secretions Gram staining, and (b) therapy: immediate treatment, empiric therapy based on local pathogens and risk factors, de-escalation, assessment of response within 72 hours, and short therapy duration if feasible.


CONCLUSIONS
Adoption of these care bundles should rationalize VAP management practices and facilitate the development of consistent and guideline-compliant care processes.
Rello
Jordi
J
Critical Care Department, Vall d'Hebron University Hospital, Institut de Recerca Vall d'Hebron-Universitat Autònoma de Barcelona, CIBER Enfermedades Respiratorias (CIBERES), Barcelona, Spain. jrello.hj23.ics@gencat.cat
Chastre
Jean
J
Cornaglia
Giuseppe
G
Masterton
Robert
R
D003191:Comprehensive Health Care / Q000458:organization & administration*; D005060:Europe; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006801:Humans; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000628:therapy*; D017410:Practice Guidelines as Topic