Implementing quality improvements in the intensive care unit: Ventilator bundle as an example

OBJECTIVE: Ventilator-associated pneumonia (VAP) is a target for health care quality improvement. The Institute for Healthcare Improvement has led the charge with its ventilator bundle aimed at VAP prevention. We set out to review the literature on the effectiveness of the bundle to prevent VAP. DESIGN: Systematic literature review. SETTING: Intensive care unit. MEASUREMENTS AND MAIN RESULTS: We identified four studies that met the inclusion criteria. The review revealed major methodologic flaws in design, reporting and results of the studies, including bias, confounding, and lack of generalizability. CONCLUSION: Lack of methodologic rigor of the reported studies precludes any conclusive statements about the bundle's effectiveness or cost-effectiveness. To assure efficient allocation of the limited healthcare resources, rigorous evaluation of optimal strategies for VAP prevention is needed to 1) establish best practices and 2) create a benchmark against which new technologies' value can be assessed. The vent bundle is not a viable quality measure in the intensive care unit at this time.