Reducing Intubations and Related Risks in Neonates with Retinopathy of Prematurity Undergoing Laser Photocoagulation.

Autor:	Quinones Cardona V; From the Division of Neonatology, Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pa.; Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pa., Byrne EM; Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pa., Arthur N; From the Division of Neonatology, Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pa.; Department of Pediatrics, CHOP Newborn Care at Women and Babies Hospital, Lancaster, Pa., Young M; Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pa., Lavery D; Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pa., Carroll A; From the Division of Neonatology, Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pa.; Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pa., Joshi S; From the Division of Neonatology, Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pa.; Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pa., Kehinde F; From the Division of Neonatology, Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pa.; Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pa., Menkiti O; From the Division of Neonatology, Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pa.; Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pa.
Jazyk:	angličtina
Zdroj:	Pediatric quality & safety [Pediatr Qual Saf] 2024 Dec 24; Vol. 10 (1), pp. e780. Date of Electronic Publication: 2024 Dec 24 (Print Publication: 2025).
DOI:	10.1097/pq9.0000000000000780
Abstrakt:	Introduction: Although associated with respiratory morbidity, elective endotracheal intubation (ETI) for laser photocoagulation for retinopathy of prematurity (ROP) is the standard practice at our institution, with 100% of patients undergoing preoperation ETI. To mitigate this risk, we strove to reduce the percentage of infants intubated for laser photocoagulation by 30% by June 2022. Methods: We assembled a multidisciplinary team and implemented a deep sedation guideline utilizing dexmedetomidine, fentanyl, and midazolam with noninvasive ventilation support for laser photocoagulation in January 2020. Outcome, process, and balancing measures tracked the efficacy and safety of the quality improvement project. Results: We reduced the percentage of infants requiring intubation for laser photocoagulation from 100% (8/8) to 10% (1/10). We reduced the average time to return to baseline respiratory status from 224.1 to 33.8 hours (9.3d to1.4 d). Cardiorespiratory index scores slightly increased (1 to 1.2), and pain scores remained unchanged after interventions. Conclusions: A multidisciplinary team approach using a deep sedation guideline and noninvasive ventilation can safely reduce the requirement for intubation during laser photocoagulation with a faster return to baseline respiratory status. (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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