(1285) Effects of PEEP Standardization on Ventilator-Associated Events in a Medical Intensive Care Unit

Introduction: In 2019, the National Healthcare Safety Network created new terminology for surveillance of Ventilator Associated Events (VAE). Triggers for VAE include an increase in FI02 by >20% or an increase in PEEP of >2.5. Previous studies have demonstrated that by using a baseline PEEP of 8, there may be a reduction in the number of VAEs per ventilator days. We implemented a PEEP of 8 protocol to assess if this new starting PEEP would decrease VAEs in our unit.

Methods: In an interdisciplinary manner, MICU leadership educated staff on the implementation of a PEEP of 8 for newly intubated patients prior to PEEP titration as opposed to the traditional starting PEEP of 5. Institutional data from the previous 30 months prior to the intervention was used as the control. The rate of VAEs for the following 9 months were then analyzed. VAEs were independently gathered by infection control and were reviewed for starting PEEP, PEEP and FIO2 adjustments, changes to antibiotics, respiratory cultures, COVID status, and timing of VAE.

Results: In the preintervention (P) group and post intervention (PI) group, 77 patients and 16 patients had VAEs respectively. This correlated to VAE rates of 8.31/1000 ventilator days in the P group and 7.54/1000 in the PI group. VAE totals for P were: 40 VAC, 33 IVAC, and 4 PVAP. The PI period had 11 VAC, 5 IVAC, and 0 PVAP. Almost half of P VAEs (44%) were due PEEP and FIO2 increases, and 25% were due to PEEP changing from 5 to 8. In the PI group, 38% had a PEEP change from 5 to 8, and 31% had increases in FIO2 and PEEP. Five percent and 13% were due to reintubation at higher vent settings in the P and PI groups respectively.

Conclusions: We did observe a reduction in VAEs and the subtypes after our intervention. Overall reduction of VAEs went from 8.31 to 7.54/1000days, IVACs from 2.85 to 2.35/1000 days and no PVAPS were noted in the 9 months evaluated during the study period. To note, a trend in a starting PEEP of 8 was noticed prior to official implementation, so the P data may have been affected, masking additional benefits of this intervention. This study demonstrated a trend in lower VAEs, and more importantly IVACs and PVAPS when utilizing a higher starting PEEP, but this needs to be further studied.