Ventilator Care Bundle Research Articles

Quality Indicators in Adult Critical Care Medicine.

Quality indicators are increasingly used in the intensive care unit (ICU) to compare and improve the quality of delivered healthcare. Numerous indicators have been developed and are related to multiple domains, most importantly patient safety, care timeliness and effectiveness, staff well-being, and patient/family-centered outcomes and satisfaction. In this review, we describe pertinent ICU quality indicators that are related to organizational structure (such as the availability of an intensivist 24/7 and the nurse-to-patient ratio), processes of care (such as ventilator care bundle), and outcomes (such as ICU-acquired infections and standardized mortality rate). We also present an example of a quality improvement project in an ICU indicating the steps taken to attain the desired changes in quality measures.

Compliance to ventilator care bundles and its association with ventilator-associated pneumonia

PurposeVentilator care bundles are effective in the prevention of ventilator-associated pneumonia (VAP). However, the compliance of these bundles in intensive care units (ICUs) remains poorly studied. This study investigates the Medical Information Mart for Intensive Care (MIMIC)-IV cohort’s compliance with the Institute for Healthcare Improvement (IHI) bundle and its resulting association with VAP incidence.MethodsThis is a retrospective cohort study of the MIMIC-IV database. Patients with > 48 h of invasive mechanical ventilation (IMV) were included. Diagnosis of VAP was identified with the International Classification of Diseases (ICD)-9 and ICD-10 codes. Compliance rates to the IHI bundle were extracted. The association of the IHI bundle and its individual interventions with VAP incidence was analyzed with univariate and multivariate analysis.Results8270 patients were included, of which 1328 (16.1%) had VAP. 25 patients (0.3%) had full compliance to the IHI bundle. 137 patients (1.7%) received no interventions from the bundle. Gastroprophylaxis had the lowest (2.1%) while head elevation had the highest (89.3%) compliance rates. In patients receiving the IHI bundle, each additional intervention was associated with lower VAP incidence (OR [odds ratio] = 0.906, 95% CI [confidence interval] 0.847–0.969). Appropriate sedation levels (OR = 0.765, 95% CI 0.661–0.885) and the use of heat and moisture exchanger (HME) filters (OR = 0.862, 95% CI 0.745–0.998) were individually associated with reduced VAP incidence, while active humidification was individually associated with increased VAP incidence (OR = 1.139, 95% CI 1.001–1.296).ConclusionThe use of the IHI bundle was associated with a lower incidence of VAP, but compliance with the bundle was poor. Appropriate sedation and HME filters were individually associated with reduced VAP incidence. Better compliance with the IHI bundle may reduce VAP rates in mechanically ventilated patients.Graphical

Prevention of Ventilator-associated Pneumonia: Knowledge and Practice of Ventilator Care Bundle among ICU Nurses of Tertiary Care Hospitals of Jodhpur, Rajasthan

Prevention of Ventilator-associated Pneumonia: Knowledge and Practice of Ventilator Care Bundle among ICU Nurses of Tertiary Care Hospitals of Jodhpur, Rajasthan

Impact on approach of ICU staff towards ventilator care bundles and infection control practices in prevention of ventilator associated pneumonia in a tertiary care hospital

Introduction and Aim: Ventilator Associated Pneumonia (VAP) infections have high morbidity and mortality. The bundle care therapy for insertion and maintenance can prevent VAP effectively. Crucial steps being mouth care with Chlorhexidine and subglottic aspiration to prevent VAP. This study focuses on the attitude of ICU health care staff towards the implementation of the ventilator care bundle. Materials and Methods: The study is a descriptive and observational cross-sectional study using a structured self-administered questionnaire without any intervention, ascertained 150 Health care staff members of ICU around the clock. The analysis was conducted using the Statistical Package for the Social Sciences (SPSS). Results: This study showed elevation of head in semi-recumbent position to have the highest acceptance frequency of 127 (84.7%) study participants. While implementation of spontaneous breathing trials had the lowest acceptance frequency of 74(49.4%) study participants. Most of the study participants have a general understanding of the steps to be taken for VAP prevention however only 39 study participants (26%) are sufficiently familiar with all the measures included in ventilator bundles when executed together are more efficient than if implemented individually. Conclusion: Due to this negative psychological attitude of ICU staff towards the implementation of the guidelines provided to them, the risk of VAP is ever-increasing suggesting a strict need for more training and education with responsibility towards improving the infection control practices on healthcare workers.

The effect of the training provided to intensive care nurses on the ventilator care bundle, aspiration knowledge level, and attitudes towards evidence-based nursing

Ventilator-associated pneumonia are common complication for patients in intensive care units [ICU] receiving mechanical ventilation. Care bundles's using by nurses in ICU can reduce this complication. The aim of this study is to compare the pre-training and post-training performance of intensive care nurses on the use of care bundle and aspiration practices, and to examine the effects of the training on their attitudes towards care bundle practices and evidence-based nursing. This study has been conducted by using the single group pretest-final test model. The EBNAQ scores of the nurses with a graduate degree and the nurses with responsibility for 0-2 patients were found to be high. Evaluation of the outputs from the ventilator care bundle and aspiration monitoring form showed a difference after the training regarding the nursing interventions conducted in all areas except for the “Performed a physical examination with auscultation over the trachea" parameter (p

Knowledge of Ventilator Care Bundles among Registered Nurses in the Intensive Care Unit at Sarawak General Hospital, Malaysia

INTRODUCTION: Ventilator Care Bundles (VCB) is a group of evidence-based highimpact interventions for mechanically ventilated patients. The study aims to identify the knowledge of VCB among Intensive Care Unit (ICU) nurses at the local hospital in Sarawak, Malaysia. MATERIALS AND METHODS: A quantitative cross-sectional survey was conducted among 30 nurses who worked in the ICU at Sarawak General Hospital, Malaysia. A modified questionnaire with 20 items was used to measure the level of knowledge. Data analysis was performed using the Statistical Package for the Social Sciences Statistics 26.0 for Windows with p< 0.05 was considered statistically significant. RESULTS: The results revealed that 86.7% (n=30) of respondents had a high-level knowledge of the VCB. There is a significant relationship between the level of knowledge of VCB and qualification as a Registered Nurse (p=0.03), ICU post-basic qualification (p=0.02), and level of nursing education (p<0.001). The level of knowledge was significantly related to the level of education (r=0.71; p<0.001), the number of years qualified as a registered nurse (r=0.38; p=0.03), and post-basic qualification (r=0.42; p=0.02). CONCLUSION: The good level of knowledge regarding VCB implementation among registered nurses indicates that they are well-equipped with the proper knowledge for caring for mechanically ventilated patients.

Prevention of ventilator-associated pneumonia through care bundles: A systematic review and meta-analysis

BackgroundVentilator-associated pneumonia (VAP) represents a common hospital-acquired infection among mechanically ventilated patients. We summarized evidence concerning ventilator care bundles to prevent VAP. MethodsA systematic review and meta-analysis were performed. Randomized controlled trials and controlled observational studies of adults undergoing mechanical ventilation (MV) for at least 48 h were considered for inclusion. Outcomes of interest were the number of VAP episodes, duration of MV, hospital and intensive care unit (ICU) length of stay, and mortality. A systematic search was conducted in the MEDLINE, the Cochrane Library, and the Web of Science between 1985 and 2022. Results are reported as odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI). The PROSPERO registration number is CRD42022341780. ResultsThirty-six studies including 116,873 MV participants met the inclusion criteria. A total of 84,031 participants underwent care bundles for VAP prevention. The most reported component of the ventilator bundle was head-of-bed elevation (n=83,146), followed by oral care (n=80,787). A reduction in the number of VAP episodes was observed among those receiving ventilator care bundles, compared with the non-care bundle group (OR=0.42, 95% CI: 0.33, 0.54). Additionally, the implementation of care bundles decreased the duration of MV (MD=−0.59, 95% CI: −1.03, −0.15) and hospital length of stay (MD=−1.24, 95% CI: −2.30, −0.18) in studies where educational activities were part of the bundle. Data regarding mortality were inconclusive. ConclusionsThe implementation of ventilator care bundles reduced the number of VAP episodes and the duration of MV in adult ICUs. Their application in combination with educational activities seemed to improve clinical outcomes.

Effect of Implementing Ventilator Care Bundle on Mechanically Ventilated Patients Outcomes

Effect of Implementing Ventilator Care Bundle on Mechanically Ventilated Patients Outcomes

Knowledge and Practices Regarding Ventilator Care Bundle for Preventing Ventilator Acquired Pneumonia (VAP) Among Intensive Care Unit Registered Nurses

Knowledge and Practices Regarding Ventilator Care Bundle for Preventing Ventilator Acquired Pneumonia (VAP) Among Intensive Care Unit Registered Nurses

Relationship between ventilator bundle compliance and the occurrence of ventilator-associated events: a prospective cohort study

BackgroundInstead of ventilator-associated pneumonia (VAP), the modern definition of ventilator-associated events (VAEs) has been introduced to identify infectious and noninfectious respiratory complications. Some studies revealed that compliance to the ventilator bundle is associated with decreased occurrence of VAP, but little is known about its association with the decrease of VAEs occurrence.MethodsA prospective cohort research design was used. Data were collected over eight months from May 2019 to February 2020 in five general intensive care units. The researchers assessed the compliance to ventilator care bundle using the Institute for Healthcare Improvement ventilation bundle checklist. Mechanically ventilated patients were prospectively assessed for the occurrence of VAEs using a pre-validated calculator from the Centers for Disease Control and Prevention. All are non-invasive tools and no intervention was done by the authors.ResultsA total of 141 mechanically ventilated patients completed the study. The odds ratio of having VAEs in patients who received ventilator bundle was -1.19 (95% CI, -2.01 to -0.38), a statistically significant effect, Wald χ2(1) = 8.18, p = 0.004.Conclusion/ implications for practiceVentilator bundle compliance was associated with a reduced risk for VAEs occurrence. Nurses should comply with the ventilator bundle because it is associated with decreased VAEs occurrence.

Impact of staffing levels and resources of intensive care units on compliance to standard mechanical ventilator guidelines: A city-wide study in times of COVID-19 pandemic.

IntroductionThe COVID‐19 pandemic has affected millions and resulted in a considerable strain on healthcare systems around the world. Intensive care units (ICUs) are reported to be affected the most because significant percentage of ICU patients requires respiratory support through mechanical ventilation (MV). This study examines the staffing levels and compliance with a ventilator care bundle in a single city in Pakistan.MethodsA cross‐sectional survey of 14 ICUs including medical and surgical ICUs was conducted through a self‐structured questionnaire including a standardized ventilator care bundle. We assessed the compliance of ICU staff to ventilator care bundle and calculated the correlation between staffing patterns with compliance to this bundle.ResultsThe unit response rate was 64% (7/11 hospitals). Across these seven hospitals, there were 14 functional ICUs (7 surgical and 7 medical). The Mean (SD) numbers of beds and ventilators were 8.14 (3.39) and 5.78 (3.68) while the average patient‐to‐nurse and patient‐to‐doctor ratio was 3: 1 and 5:1 respectively. The median ventilator care bundle compliance score was 26 (IQR = 21–28) out of 30, while in medical and surgical ICUs, median scores were 24 (IQR = 19–26) and 28 (IQR = 23–30) respectively. The perceived least compliant component was head elevation in ventilated patients. Correlation analysis revealed that 24 h a day, 7 days a week onsite cover of Advanced Cardiovascular Life Support certified staff was positively correlated with the ventilator care bundle score (r s = 0.654, p value = .011). Similarly, 24‐h cover of senior ICU nurses was significantly correlated with the application of chlorhexidine oral care (r s = 0.676, p value = .008) while routine subglottic aspiration was correlated with the number of doctors (r s = 0.636, p value = .014).ConclusionOur study suggests that ICUs in Peshawar are not well staffed in comparison with international standards and the compliance of ICUs with the ventilator care bundle is suboptimal. We found only a few aspects of ventilator care bundle compliance were related to nursing and medical staffing levels.Relevance to clinical practiceCritical care staffs at most of the medical ICUs in Peshawar are not compliant with the standard guidelines for patients on mechanical ventilation. Moreover, the staffing levels at these ICUs are not in accordance with international standards. However, this study suggests that staffing levels may not be the only cause of non‐compliance with standard mechanical ventilator guidelines. There is an urgent need to design and implement a program that can enhance and monitor the quality of nursing care provided to mechanically ventilated patients. Lastly, nurse staffing of ICUs in Pakistan must be increased to enable high quality care and more doctors should be trained in critical care.

Weaning success among COPD patients following ventilator care bundle application

Objective: Several studies evaluated the effectiveness of the ventilator care bundle in reducing the occurrence of ventilatorassociated pneumonia. The ventilator care bundle efficacy in early mechanical ventilation weaning has not been adequately assessed. The study aimed to investigate the weaning success among chronic obstructive pulmonary disease (COPD) patients following ventilator care bundle application.Methods: This study is quasi-experimental, recruiting 80 mechanically ventilated COPD patients (40 patients for each bundle and control group). It was conducted at the respiratory intensive care units (ICUs) at Mansoura University Hospital, Egypt. Data were collected using a mechanically ventilated patient (MVP) assessment tool, a ventilator care bundle compliance checklist, and MVP evaluation tools based on the Burns’ Wean Assessment Program (BWAP) checklist and the patient’s ventilation indicators.Results: The results revealed that almost 75% of the bundle group was successfully weaned from invasive mechanical ventilation at the first attempt of the spontaneous breathing trial compared with 32.5% of the control group. The ventilation duration and length of ICU stay were reduced in the bundle compared with the control group.Conclusions: The bundle group demonstrated higher weaning scores than the control group. Therefore, we recommend the integration of the ventilator care bundle in the weaning trial of MVPs to accelerate weaning and reduce the duration of mechanical ventilation.

Investigation of the airway management practice of emergency department ward nurses: a nationwide survey in China

ObjectivesTo investigate the airway management equipment and clinical practice in emergency department wards in China, and to explore the factors that influenced the nurses’ airway management practice.DesignCross-sectional study.SettingA nationwide survey...

Effective Implementation of Ventilator Care Bundles in Improves Outcomes: A Multicenter Randomized Controlled Clinical Trial.

To evaluate the effect of 17-ventilator care bundles and different training strategies for critical care nurses on clinical outcomes. A randomized controlled triple-blinded clinical trial. The multicenter study was conducted in four academic teaching hospitals in Tehran, Iran, from October 2011 to June 2015. A total of 1,600 adult patients (age ≥ 18 yr) who were admitted to mixed medical-surgical ICUs (> 72 hr) and received invasive ventilation (> 48 hr) were included in this study. In addition, 160 critical care nurses were recruited through letters and telephone and face-to-face invitations. Seventeen-ventilator care bundles applied by four different groups of nurses. Clinical outcomes were compared between four groups of study which include three intervention groups (who received 17-ventilator care bundles by trained nurses) and one control group (who received routine care). According to the results, ICU length of stay, non-ICU length of stay, ventilator-associated pneumonia occurrence date, ventilator-associated pneumonia, and mortality rates were significantly higher in control group compared with other groups. Critical care nurses training program to accurately implement 17-ventilator care bundles improves outcomes.

The Impact of a Multidisciplinary Education Program for Intensive Care Unit Staff Regarding Ventilator Care Bundle on the Frequency of Ventilator-Associated Events.

Ventilator bundles have been reported to reduce the risk of ventilator-associated pneumonia. However, data concerning the role of the education of the intensive care unit (ICU) staff regarding the items in the bundle and the importance to adhere to its items on the development of ventilator-associated events (VAEs) are limited. This study aimed to compare the frequency of VAEs in subjects admitted to the ICU before and after the education of the ICU staff. A total of 105 subjects were enrolled in this retrospective study. The ICU staff, including the physicians, respiratory therapists, and nurses, received a 2-day educational lecture regarding items in the bundle as well as the need to adhere to its items. The study population was divided into two according to the admission date: subjects who were admitted before the education of the ICU staff regarding the ventilator bundle (preeducation) and subjects who were admitted after the education of the ICU staff regarding the ventilator bundle (posteducation). The difference in VAE rate in subjects admitted before and after bundle training was the primary outcome measure of this study. The bundle compliance rates presented by days were significantly higher in the posteducation group compared with the preeducation group. Moreover, the frequency of VAEs was significantly lower in posteducation subjects compared with preeducation subjects (4.7% vs 19.0%, P = .042). Ventilator-associated event rate was also lower in posteducation subjects compared with preeducation subjects (2.5/1000 vs 9.8/1000 ventilator days). There were no significant differences among the groups with respect to ICU mortality. The educational intervention performed in this study not only increased the adherence to the ventilator care bundle but also led to a significant reduction in the rate of the VAEs in patients receiving mechanical ventilator support in the ICU.

A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON LEVEL OF KNOWLEDGE REGARDING VENTILATOR CARE BUNDLE IN PREVENTION OF VENTILATOR-ASSOCIATED PNEUMONIA IN INTUBATED PATIENTS AMONG B.SC NURSING IIIRD YEAR STUDENTS AT SELECTED SHRI GURU RAM RAI UNIVERSITY, COLLEGE OF NURSING, DEHRADUN

Problem Statement: A study to evaluate the effectiveness of planned teaching programme on level of knowledge regarding ventilator care bundle in preventionofventilator-associatedpneumonia in intubated patients among B.Sc Nursing IIIrd year atselectedShri Guru Ram Rai University, College of Nursing, Dehradun. Objectives: To assess the pre-test knowledge scores of students regarding ventilator care bundle in prevention of ventilator-associated pneumonia in intubated patients using a structured knowledge questionnaire. To evaluate the effectiveness of planned teaching programme for students regarding ventilator care bundle in prevention of ventilator-associated pneumonia in terms of gain in post-test knowledge scores. To associate the knowledge score of students regarding ventilator care bundle in prevention of ventilator-associated pneumonia with selected demographic variables. Methodology: The nature of the study was pre-experimental approach i.e. One group pre-test and post-test without a control group design. The conceptual framework used in this study was based on General System Theory developed by Ludwig Von Bertalanffy. The research design used for this study was based on one group pre-test and post-test without a control group design. The present study attempts to evaluate the effectiveness of planned teaching programme on level of knowledge regarding ventilator care bundle in prevention of ventilator-associated pneumonia in intubated patients among B.Sc Nursing IIIrd year students. This study included 60B.Sc Nursing IIIrd year students and their level of knowledge was assessed by using self-structuredknowledgequestionnaire. Planned teaching programme was implemented through power-point presentation and post-test was conducted after 7 days using same questionnaire. The effectiveness of planned teaching programme was evaluated by comparing the level of knowledge score in pre-test and post-test through descriptive and inferential statistics. Results: Maximum percentage of students 68.3% were in age group between 21-25 years. Highest percentages of students 93.3% were females. Majority of students 80% were Hindu. Most of the students 95% were graduated. Majority of the students 76.7% were residing in urban area. Highest percentages of students 76.7% had not witnessed a case of ventilator-associated pneumonia. Majority of students 85% had not undergone any educational training programme on ventilator-associated pneumonia. Majority of the students 28.3% gained knowledge regarding VAP from electronic media and hospital health information as a source of information. The post-test mean knowledge score percentage was 71.5% was found higher when compared with pre-test mean knowledge score percentage 48.06%. The statistical paired t test indicates that the mean post-test score percentage (71.5%) was significantly higher than the mean pre-test score percentage (48.06%) at the 0.001 level of significance this shows that the planned teaching programme was effective in increasing level of knowledge of students regarding ventilator care bundle in prevention of ventilator-associated pneumonia. There was no significant association between age, gender, religion, academic qualification, locality, have they ever witnessed a case with VAP, have they ever undergone any educational training programme on prevention of VAP and source of information on prevention of VAP with the knowledge score of the students. Conclusion: The results revealed that mean knowledge score percentage in post-test is higher than the mean knowledge score percentage in pre-test. Overall findings shows that there was knowledge deficit among students regarding ventilator care bundle in prevention of ventilator-associated pneumonia and planned teaching programme was effective in improving their level of knowledge.

Evaluation of the effects of applying the ventricular care bundle (VCB) method for reducing ventilator-associated pneumonia (VAP) in the intensive care unit of a general Chinese tertiary hospital.

Ventilator-associated pneumonia (VAP) is a severe complication that occurs within patients who must use ventilators in the intensive care unit (ICU). Ventilator care bundles (VCB) have been applied across many developed regions and have produced positive results in controlling VAP. In this study, we report on the implementation and effects of using VCBs to manage VAP in a general tertiary hospital in the Inner Mongolia Autonomous Region of China. A targeted surveillance method was used to survey all the patients (n=4,716) in the ICU from June 1, 2017 to May 31, 2019. Patients from June 1, 2017 to May 31, 2018, and June 1, 2018, to May 31, 2019, were respectively divided into 2 groups: the control group (2,029 patients) and intervention group (2,687 patients). These dates were selected because VCB was implemented from June 1, 2018, in our institution. The variables that were associated with VCB and observed were the head-of-bed elevation, oral care, maintenance of the pressure for the cuff of the endotracheal tube, aspiration of subglottic secretion, daily sedation vacation protocol, daily extubation assessment results, and hand hygiene. After collecting the data, the compliance of VCB, ventilator use ratio, and the incidence rate of VAP in these 2 groups were compared. We observed that compliance with all of the intervention measures for VCB improved results in the intervention group compared to the control. Furthermore, the compliance rate of hand hygiene increased from 71.99% to 91.97%, and the head-of-bed elevation of 30°-45° increased from 62.02% to 85.96%. All differences between these two groups were statistically significant, according to the χ 2 -test. The ventilator use ratio was statistically and significantly lower in the intervention group (34.86%) compared to the control group (40.29%) (χ 2 =95.513, P<0.001). The incidence rate of VAP was statistically and significantly lower in the intervention group (13.70‰) compared to the control group (18.85‰) (χ 2 =5.471, P=0.019). Our results show that VCB prevents VAP. Therefore, personnel training, clinical supervision, and surveillance feedback could promote a reduction in intervention measures.

Knowledge and practice of ventilator care bundle for preventing ventilator associated pneumonia by ICU nurses of tertiary care hospitals of Lahore

Ventilator associated pneumonia (VAP) is the most common nosocomial infection acquired by patients in an intensive care unit (ICU). However, there is scarce clinical data, particularly from Pakistani ICUs, regarding existing practices to prevent it.

Use of Ventilator Care Bundle to Prevent Ventilator-Associated Pneumonia: The Impact of Using Echinacea as a Complementary Modality

Abstract Background: Ventilator Associated Pneumonia (VAP) is one of the most common hospital acquired infections in Intensive Care Unit. It is a complication in many patients who receive mechanical ventilation. One of the recent approaches for prevention of VAP was the application of ventilator care bundle which includes; head of bed elevation, deep vein thrombosis prophylaxis, peptic ulcer disease prophylaxis, daily sedation vacation, daily assessment for readiness for extubation, daily spontaneous breathing trial, and oral care with chlorohexadine. Echinacea is a herb that has been utilized to strengthen the body's innate resistance. It contains multiple active compounds which gives it its medicinal qualities, it has been shown to reduce the severity of respiratory infections. This herb may be used in prophylaxis against VAP. Aim of Study: The objective of this study was to evaluate the effect of adding Echinacea to ventilator care bundle in intubated and ventilated ICU patient on prophylaxis against ventilator associated pneumonia. Material and Methods: This clinical trial included 80 patients who were intubated and mechanically ventilated within 48 hours of admission to ICU in Surgical Intensive Care Unit (SICU) in Kasr Aini Hospital during the period between December 2013 and December 2014. All patients were adults more than 18 years, who have no witnessed aspiration or pneumonia on admission. Intervention: Patients were divided into two equal groups of 40 patients each, one group received Echinacea in the form of Immulant capsules and the other didn't receive it. Both groups have ventilator care bundle applied. All patients were followed-up clinically, radiologically and by laboratory as-sessment. VAP was suggested according to Clinical Pulmonary Infection Score (CPIS). Results: Inflammatory indicators in the form of occurrence of fever and rising trend in the count of WBCs in the first five days were significantly less in the group that received Echinace. Gram negative organisms were the most prevalent in cases with VAP with no statistical difference between both groups in the type of organisms. VAP rate had no significant difference between the two groups. Conclusion: No apparent difference is found on adding Echinacea to ventilator care bundle on prevention of VAP, But Echinacea may be found to decrease severity of inflam-matory reactions reducing VAP complications.

The Impact of Using Echinacea as a Complementary Modality on ICU Length of Stay and Mortality in Intubated and Ventillated Patient

Abstract Background: Ventilator Associated Pneumonia (VAP) is a common concern in Intensive Care Unit (ICU), where many risk factors have been reported to be associated with it. VAP can increase patient's length of stay in ICU and possibly causes high mortality rate. Application of several interventions have been found to reduce incidence of VAP, including head of bed elevation, deep vein thrombosis prophylaxis, peptic ulcer disease prophylaxis, daily sedation vacation, daily assessment for readiness for extubation, daily spontaneous breathing trial, and oral care with chlorohexadine. These interventions are called ventilator care bundle. Echinacea is a herb that has been utilized to strengthen the body's innate resistance. It contains multiple active compounds which gives it its medicinal qualities, it has been shown to reduce the severity of respiratory infections. Aim of Study: The aim of this study was to evaluate the effect of adding Echinacea to ventilator care bundle in intubated and ventilated ICU patient on length of stay in ICU and mortality. Material and Methods: This clinical trial included 80 patients who were intubated and mechanically ventilated within 48 hours of admission to ICU in Surgical Intensive Care Unit (SICU) in Kasr Aini Hospital during the period between December 2013 and December 2014. All patients were adults more than 18 years, who have no witnessed aspiration or pneumonia on admission. Intervention: Patients were divided into two equal groups of 40 patients each, one group received Echinacea in the form of Immulant capsules and the other didn't receive it. Both groups have ventilator care bundle applied. All patients were followed-up clinically, radiologically and by laboratory. Length of ICU stay, mortality and VAP associated mortality were calculated in both groups. Results: Both length of stay in ICU and mortality had no statistical significance in both groups, but VAP associated mortality had decreased significantly in the group that received Echinacea. Conclusion: Echinacea may be found to decrease VAP associated mortality.