title: Daily multidisciplinary rounds to implement the ventilator bundle decreases ventilator-associated pneumonia in trauma patients: but does it affect outcome?
abstract: BACKGROUND
  The incidence of ventilator-associated pneumonia (VAP) in trauma patients can be decreased with use of the ventilator bundle (VAPB). Our VAP rate remained high despite the adoption of the VAPB. To better implement the VAPB, a multidisciplinary team composed of the surgical intensive care unit (SICU) nursing staff, physician, and respiratory therapist reviewed briefly a checklist of VAPB goals for each patient before morning attending rounds. We hypothesized that such daily goal rounds (GR) focused on the VAPB would decrease the VAP rate.
  
  
  METHODS
  A pre-GR ten-month period (November 2006 to August 2007) was compared with the ten-month period (September 2007 to June 2008) with daily GRs. The occurrence of VAPs was tallied prospectively in all intubated trauma patients using the National Nosocomial Infection Surveillance criteria. Patient characteristics and outcome data were obtained from our trauma registry and medical records. Patient characteristics were similar in the 85 pre-GR patients and the 89 GR patients.
  
  
  RESULTS
  The number of VAPs decreased 67% in the GR patients (15 pre-GR vs. 5 GR; p=0.02); however, the all-cause mortality rate remained similar (16.5% vs. 21.3%; p=0.41). When patients were divided into those with and without VAP, there was a significant increase in mean ventilator, SICU, and hospital days in patients with VAP (p=0.01 for all). There were only two deaths among trauma patients with VAP.
  
  
  CONCLUSIONS
  Daily multidisciplinary GRs focused on the VAPB can decrease the incidence of VAP significantly in trauma patients. Ventilator-associated pneumonia correlated with extended mean ventilator, SICU, and hospital days. Interestingly, despite a significant decrease in VAP, a decrease in the mortality rate was not observed. Given the small number of deaths in the VAP cohort, this study has insufficient statistical power to elucidate the true impact of GR intervention or VAP on the mortality rate in trauma patients.
authors.affiliation: Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York 10461, USA. Melvin.Stone@NBHN.net
authors.forename: Melvin E
authors.initials: ME
authors.lastname: Stone
authors.forename: David
authors.initials: D
authors.lastname: Snetman
authors.forename: Andrea
authors.initials: A
authors.lastname: O' Neill
authors.forename: Janet
authors.initials: J
authors.lastname: Cucuzzo
authors.forename: Joseph
authors.initials: J
authors.lastname: Lindner
authors.forename: Salman
authors.initials: S
authors.lastname: Ahmad
authors.forename: Sheldon
authors.initials: S
authors.lastname: Teperman
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000517:prevention & control*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications* / Q000628:therapy