Spillover of Early Extubation Practices From the Pediatric Heart Network Collaborative Learning Study.

Autor:	Witte MK; Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT., Mahle WT; Department of Pediatrics, Emory University, Atlanta, GA., Pasquali SK; Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI., Nicolson SC; Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA., Shekerdemian LS; Department of Pediatrics, Baylor College of Medicine, Houston, TX., Wolf MJ; Department of Pediatrics, Emory University, Atlanta, GA., Zhang W; Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI., Donohue JE; Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI., Gaies M; Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI.
Jazyk:	angličtina
Zdroj:	Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies [Pediatr Crit Care Med] 2021 Feb 01; Vol. 22 (2), pp. 204-212.
DOI:	10.1097/PCC.0000000000002620
Abstrakt:	Objectives: The Pediatric Heart Network Collaborative Learning Study used collaborative learning strategies to implement a clinical practice guideline that increased rates of early extubation after infant repair of tetralogy of Fallot and coarctation of the aorta. We assessed early extubation rates for infants undergoing cardiac surgeries not targeted by the clinical practice guideline to determine whether changes in extubation practices spilled over to care of other infants. Design: Observational analyses of site's local Society of Thoracic Surgeons Congenital Heart Surgery Database and Pediatric Cardiac Critical Care Consortium Registry. Setting: Four Pediatric Heart Network Collaborative Learning Study active-site hospitals. Patients: Infants undergoing ventricular septal defect repair, atrioventricular septal defect repair, or superior cavopulmonary anastomosis (lower complexity), and arterial switch operation or isolated aortopulmonary shunt (higher complexity). Interventions: None. Measurements and Main Results: Aggregate outcomes were compared between the 12 month pre-clinical practice guideline and 12 months after study completion (Follow Up). In infants undergoing lower complexity surgeries, early extubation increased during Follow Up compared with Pre-Clinical Practice Guideline (30.2% vs 18.8%, p = 0.006), and hours to initial postoperative extubation decreased. We observed variation in these outcomes by surgery type, with only ventricular septal defect repair associated with a significant increase in early extubation during Follow Up compared with Pre-Clinical Practice Guideline (47% vs 26%, p = 0.006). Variation by study site was also seen, with only one hospital showing an increase in early extubation. In patients undergoing higher complexity surgeries, there was no difference in early extubation or hours to initial extubation between the study eras. Conclusions: We observed spillover of extubation practices promoted by the Collaborative Learning Study clinical practice guideline to lower complexity operations not included in the original study that was sustainable 1 year after study completion, though this effect differed across sites and operation subtypes. No changes in postoperative extubation outcomes following higher complexity surgeries were seen. The significant variation in outcomes by site suggests that center-specific factors may have influenced spillover of clinical practice guideline practices. Competing Interests: Dr. Witte’s institution received funding from the Pediatric Heart Network/National Heart, Lung, and Blood Institute. Drs. Witte, Mahle, Pasquali, and Gaies received support for article research from the National Institutes of Health (NIH). Dr. Pasquali’s institution received funding from the NIH. Dr. Zhang disclosed work for hire. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2020 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)
Databáze:	MEDLINE
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