Abstract
Background:
Akron Children's Hospital (ACH) NICUs' chronic lung disease (CLD) rate increased despite continued efforts to concentrate work in this area. We hypothesized that membership in the Vermont Oxford Network Minimizing Lung Injury Homeroom with a more collaborative, multi-disciplinary direction could improve outcomes.
Methods:
A pilot process and algorithm was designed within the multi-disciplinary group to address ventilation and surfactant strategy from intubation to extubation. An intense weekly meeting schedule was designed with medical providers, nursing, family representatives and respiratory therapists. The key drivers of change included the application of an updated ventilator algorithm, education to the staff, and several PDSA (plan do study act) cycles. These were implemented to standardize a respiratory strategy including the use of early nasal continuous positive pressure (NCPAP), earlier surfactant administration with more precise intubation criteria, and timely extubation to noninvasive ventilation (NIV). The primary goal of decreasing intubated time on the ventilators was reflected by comparing the VON data of conventional ventilation at 36 weeks gestation age. Statistical tests used were T-test and Z-test.
Results:
Data was analyzed for infants <29 weeks pre-implementation in 2016 (n= 25) and in 2017 (n= 19) after implementation of the algorithm. The primary goal of decreasing time on the ventilator trended toward improvement with extubation time from 34 to 21 h after implementation of the algorithm (P= 0.09). Timing to administration of surfactant was 64 min pre-implementation and trended downwards to 36.5 min (P= 0.06) after implementation of the process. The primary goal of decreasing intubation time was demonstrated with 26% of the infants in 2016 compared to 7.2% in 2017 (P= 0.013). There was no difference in the pneumothorax rate which was used as a balancing measure.
Conclusions:
Use of the multidisciplinary team, frequent education forums and algorithms has trended towards less intubation time, less time to surfactant administration, and fewer patients on ventilators at 36 weeks gestational age. We anticipate that with larger numbers of patients and the continued efforts of this multi-disciplinary collaborative effort in the NICU, patient outcomes will continue to improve.
Get full access to this article
View all access options for this article.