OBJECTIVE: Ventilator associated pneumonia is the most frequent health-care-associated infection in Intensive Care Units, causing increased antibiotic consumption and resistance, length of stay, plus multiple health and economic costs. The aim of the study was to assess whether a customised guideline implementation would improve ventilator-associated pneumonia incidence and associated intensive care outcomes.
METHODS: This was a quasi-experimental, before-after study consisting of pre-intervention, intervention and post-intervention periods.
METHODS: Three intensive care units at a well-known Portuguese hospital centre.
METHODS: A set of eight recommendations was implemented after a guideline adaptation process.
METHODS: Adult patients admitted to the intensive care units over the study periods, aged 18 years or older and under invasive ventilation through an endotracheal tube or tracheostomy cannula.
RESULTS: Data related to patient characterisation, guideline compliance and health outcomes were analysed. From a population of 1970 patients, a study sample of 828 was studied. Compliance with the recommendations was high. We identified a significant reduction in the incidence of ventilator-associated pneumonia in two of the units (p = 0.020 and p = 0.001) and a reduction in duration of invasive ventilation, intensive care unit length of stay and mortality in all the three units. We found associations between some recommendations and the implementation of the set of recommendations and intensive care unit length of stay, duration of invasive ventilation and mortality.
CONCLUSIONS: The implementation of an evidence-based, locally customised guideline may improve ventilator associated pneumonia incidence and several outcomes.

OBJECTIVE: The German society of trauma surgery published the \"Treatment of Patients with Severe and Multiple injuries\" guideline in 2011. This achieved the highest level of recommendation for guidelines published in Germany. This study investigated if there was an improvement in the survival rates of severed injured patients following the introduction of the guideline in clinical treatment.
METHODS: All patients with an injury severity score ≥16 on primary admission to hospital between January 2010 and December 2012 (a total of 373 patients) were included in this study. The data for these patients were collected from the German Trauma Registry and from patients\' hospital records. Patients who were treated in 2010 were compared with patients who were treated in 2011 and 2012, following the introduction of the \"treatment of patients with severe and multiple injuries\" guideline in the authors\' clinic at the beginning of 2011.
RESULTS: Significant differences were found in ISS, RTS, New ISS, and TRISS between 2010 and 2011/2012. No differences were found in the severity of injury when classified by different body regions. Major differences were found in the total volume replacement, the length of emergency surgery, the length of surgery performed within the first 24h and the rate of whole-body computed tomography. The mortality rate dropped from 32.48% in 2010 to 18.75% in 2011/2012 (p=0.003).
CONCLUSIONS: The introduction and use of a guideline-based medical care regime for severely injured patients might reduce the rate of mortality.