Respiratory Therapist Driven Ventilator Bundle Adherence And Patient Outcomes: Lung Protective Ventilation, Sedation Coordination, Oral Care, And Proning Implementation

Abstract

Background: Respiratory therapist (RT) driven ventilator bundles promote lung-protective ventilation, sedation, oral care, VAP prevention, and proning coordination. We evaluated whether adherence to these elements is linked to better outcomes in mechanically ventilated adults. Methods: We systematically reviewed original studies identified from electronic databases. Eligible studies include ventilated adults and evaluated an RT-driven or RT-integrated bundle element, reporting adherence or clinical outcomes. Two reviewers screened and extracted data, and findings were synthesized narratively by bundle domain. Results: Eight studies met inclusion criteria in emergency department and ICU settings. Lung-protective ventilation initiatives improved adherence; some cohorts reported lower mortality and more VFD. ICU liberation approaches were associated with fewer delirium, early VAP events and shorter ventilation duration. VAP bundle audits showed higher compliance with lower VAP rates. Conclusion: RT-driven bundle adherence aligns with improved patient centered outcomes, although effects differ by component and study design. Standardized adherence definitions and risk adjusted evaluations are needed.