CDC Prevention Epicenters Wake Up and Breathe Collaborative

Study Description

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Brief Summary:

Ventilator-associated pneumonia (VAP) is a common complication of mechanical ventilation associated with significant morbidity, including prolongation of mechanical ventilation and increased ICU and hospital length-of-stay. Numerous strategies have been proposed to decrease the occurrence of VAP among ventilated patients. Most notably, optimizing the use of daily sedative interruptions and daily spontaneous breathing trials can improve sedative management, decrease ventilator time, improve outcomes for mechanically ventilated patients,and possibly decrease VAP.Combining daily sedative interruption with daily spontaneous breathing trials confers additive improvement in ventilator days, intensive care days, and possibly mortality compared to daily spontaneous breathing trials alone.

The primary aim of this study is to determine the impact of an opt-out protocol for paired daily sedative interruptions and spontaneous breathing trials on VAP rates using a new streamlined VAP definition. The investigators will evaluate the responsiveness of CDC's proposed new surveillance definitions for ventilator-associated events to this quality improvement initiative. The study will be nested within the Epicenters Streamlined versus Conventional VAP Surveillance Study. Nine of the 18 hospitals in the larger study will be participating in this intervention arm.

Condition or disease	Intervention/treatment	Phase
Ventilator-associated Pneumonia	Procedure: Daily SAT & SBT	Not Applicable

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	3342 participants
Intervention Model:	Single Group Assignment
Masking:	None (Open Label)
Primary Purpose:	Treatment
Official Title:	CDC Prevention Epicenters Wake Up and Breathe Collaborative
Study Start Date :	May 2012
Actual Primary Completion Date :	June 2013
Actual Study Completion Date :	October 2013

Arms and Interventions

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Arm	Intervention/treatment
Experimental: Opt Out Protocol	Procedure: Daily SAT & SBT; Nurse and/or respiratory therapist led daily awakenings from sedation (spontaneous awakening trial, or SAT) and daily performance of a spontaneous breathing trial (SBT) among mechanically ventilated, critically ill patients in participating ICUs.

Outcome Measures

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Primary Outcome Measures :

1. Change in VAC rate. [ Time Frame: 12 months ]

   A new definition for VAP is the primary focus of this study. This new definition (referred to as "streamlined VAP" or "sVAP") is under consideration by the CDC as a potential replacement for the current NHSN VAP definition and, as such, will be closely evaluated to determine if it can reflect meaningful changes in patient care. Thus, we will assess the change in monthly sVAP rates from study start to study end using an interrupted time series analysis.

   Note that CDC released new surveillance definitions for ventilator-associated events in late 2012. Given that CDC definitions are the defacto surveillance standard, we switched the primary study outcome from sVAP to ventilator-associated conditions ("VAC"). All data elements required to assess for VAC were included in this study from the outset hence we did not have to collect any additional historical data in order to apply CDC's VAC definition.

Secondary Outcome Measures :

1. ICU-specific outcomes [ Time Frame: 12-months ]
   • NHSN VAP rate
   • Mechanical ventilation days per patient
   • Ventilator-free days assessed over 28 days post-intubation
   • ICU length of stay per patient
   • Average antibiotic days
   • Rates of extubation and reintubation within 48 hours
2. Hospital-specific outcomes [ Time Frame: 12-months ]
   • Hospital length of stay
   • Hospital mortality
3. Patient-specific outcomes [ Time Frame: 12-months ]
   • Mean ventilator days
   • Mean ICU days
   • Mean hospital days

   The above results will also be assessed separately for patients who received opt-out protocol care versus those who did not.

Eligibility Criteria

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Ages Eligible for Study:	Child, Adult, Senior
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

• all patients in participating units on mechanical ventilation for at least one calendar day beting treated with continuous sedatives or standing orders for sedatives. Patients receiving mechanical ventilation through either an endotracheal or tracheostomy tube will be eligible.

Exclusion Criteria:

• moribund status or plans for withdrawal of life support

Contacts and Locations

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Locations

United States, Illinois
Chicago Prevention Epicenter
Chicago, Illinois, United States
United States, Massachusetts
North Shore Medical Center
Salem, Massachusetts, United States
United States, Missouri
Washington University Prevention Epicenter
St. Louis, Missouri, United States
United States, North Carolina
Duke University Prevention Epicenter
Durham, North Carolina, United States
United States, Pennsylvania
University of Pennsylvania Prevention Epicenter
Philadelphia, Pennsylvania, United States

Sponsors and Collaborators

Harvard Pilgrim Health Care

Centers for Disease Control and Prevention

Washington University School of Medicine

Rush University Medical Center

University of Pennsylvania

Duke University

North Shore Medical Center

Investigators

Principal Investigator:	Michael Klompas, MD, MPH	Harvard Pilgrim Health Care

More Information

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Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Klompas M, Anderson D, Trick W, Babcock H, Kerlin MP, Li L, Sinkowitz-Cochran R, Ely EW, Jernigan J, Magill S, Lyles R, O'Neil C, Kitch BT, Arrington E, Balas MC, Kleinman K, Bruce C, Lankiewicz J, Murphy MV, E Cox C, Lautenbach E, Sexton D, Fraser V, Weinstein RA, Platt R; CDC Prevention Epicenters. The preventability of ventilator-associated events. The CDC Prevention Epicenters Wake Up and Breathe Collaborative. Am J Respir Crit Care Med. 2015 Feb 1;191(3):292-301. doi: 10.1164/rccm.201407-1394OC.

Responsible Party:	Michael Klompas MD, MPH, FRCPC, Principal Investigator, Harvard Pilgrim Health Care
ClinicalTrials.gov Identifier:	NCT01583413 History of Changes
Other Study ID Numbers:	PH000410A-2; 3U54CK000172-01S1 ( U.S. NIH Grant/Contract )
First Posted:	April 24, 2012
Last Update Posted:	October 11, 2013
Last Verified:	October 2013

Keywords provided by Michael Klompas MD, MPH, FRCPC, Harvard Pilgrim Health Care:

Ventilator-associated pneumonia

Additional relevant MeSH terms:

Pneumonia; Pneumonia, Ventilator-Associated; Lung Diseases; Respiratory Tract Diseases; Respiratory Tract Infections	Cross Infection; Infection; Ventilator-Induced Lung Injury; Lung Injury