Original Article
Open Access: ICU-Broncho-Aspiration Protocols Monitoring at an Academic Health Network System
Abstract
Objectives: The objectives were to determine intensive care unit (ICU) incidence of broncho-aspiration (BA) and the effect of monitoring BA prevention protocols.Methods: The Health Network Warehouse was interrogated for the diagnosis of BA in patients older than 18 years in the surgical ICU (SICU) from January 2010 to December 2020. A BA prevention bundle protocol was prospectively monitored during all consecutive SICU admissions from August 2021 to November 2021 until discharge/death (n = 159). Experimental subjects were matched for age, sex, body mass index, and comorbidities with historical controls (BA− and BA+) as a propensity score analysis study. The BA prevention bundle protocol consisted of head-of-bed elevation at 30°, acid-suppressive medication, and daily administration of mouthwash. Univariate/multivariate analyses were conducted (P < 0.05).
Results: The BA incidence over a 10-year period was 5.6%. Before study initiation, random monitoring showed a mean bundle protocol compliance of 29% (18%–39%). After the introduction of protocol monitoring, compliance increased to 92% despite an upsurge in temporary nurses serving in the ICU. There was a total of 795 daily entries, with a mean head-of-bed elevation of 29.8° ± 13°, and a 10-fold decrease in BA (from 5.6% to 0.6%, P < 0.01).
Conclusions: Implementation and monitoring of a BA prevention protocol significantly reduced the rate of BA in the SICU.
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