Improving Respiratory Support Practices to Reduce Chronic Lung Disease in Premature Infants.

Autor:	Levesque BM; Division of Neonatology, Boston Medical Center, Boston, Mass.; Boston University School of Medicine, Boston, Mass., Burnham L; Division of General Pediatrics, Boston Medical Center, Boston, Mass., Cardoza N; Department of Respiratory Therapy, Boston Medical Center, Boston, Mass., Adams M; Department of Nursing, Boston Medical Center, Boston, Mass., Cohen R; Boston University School of Medicine, Boston, Mass.; Division of Pediatric Pulmonology, Boston Medical Center, Boston, Mass., Mirochnick M; Division of Neonatology, Boston Medical Center, Boston, Mass.; Boston University School of Medicine, Boston, Mass., Fujii A; Division of Neonatology, Boston Medical Center, Boston, Mass.; Boston University School of Medicine, Boston, Mass., Sinha B; Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Mass.; Harvard Medical School, Boston, Mass.
Jazyk:	angličtina
Zdroj:	Pediatric quality & safety [Pediatr Qual Saf] 2019 Aug 09; Vol. 4 (4), pp. e193. Date of Electronic Publication: 2019 Aug 09 (Print Publication: 2019).
DOI:	10.1097/pq9.0000000000000193
Abstrakt:	Introduction: We implemented a bundle of respiratory care practices and optimized delivery of continuous positive airway pressure (CPAP) to reduce the incidence of chronic lung disease (CLD) among very low birth weight (VLBW) infants born before 33 weeks gestation. Methods: Our multidisciplinary task force utilized 6 plan-do-study-act cycles to test our interventions. The primary outcome was the quarterly percentage of infants diagnosed with CLD; other outcomes included the percentage of infants initially managed with CPAP, intubation <72 hours of age, use of a nasal cannula, and days of ventilation, oxygen, and/or CPAP. Process measures included compliance with each of the 5 components of the bundle; balancing measures included mortality and complications of prematurity. Results: Demographics were similar in the 55 infants born before and 76 infants born after the task force interventions, except for gestational age, which was lower before. CLD decreased by 55.5% (from 37.5% to 16.7%). Quarterly percentage of infants requiring intubation decreased from 87.5% to 40.8%. Quarterly average days of ventilation decreased from 11.2 to 6.1, and days of supplemental oxygen declined from 44.1 to 25.4, while the use of CPAP increased. There were no differences in adverse events including mortality, pneumothorax, use of postnatal steroids, or any retinopathy of prematurity. The incidence of patent ductus arteriosus declined from 60% to 33% ( P < 0.01). Conclusions: We reduced the incidence of CLD among our very low birth weight infants born before 33 weeks gestation by over 50% without increasing any measured adverse outcomes. The incidence of patent ductus arteriosus declined. (Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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