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Decreasing Intubation for Ineffective Ventilation after Birth for Very Low Birth Weight Neonates
Despite recommendations promoting noninvasive delivery room (DR) ventilation, local historical preterm DR noninvasive ventilation rates were low (50%−64%). Project aims were to improve DR noninvasive ventilation rate in very low birth weight (VLBW) neonates (<1500 g) with a focus on decreasing DR...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9345641/ https://www.ncbi.nlm.nih.gov/pubmed/35928022 http://dx.doi.org/10.1097/pq9.0000000000000580 |
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author | Herrick, Heidi M. Weinberg, Danielle D. James, Jennifer Murray, Ashley Brown-Jackson, Loretta Chaudhary, Aasma Posencheg, Michael A. Foglia, Elizabeth E. |
author_facet | Herrick, Heidi M. Weinberg, Danielle D. James, Jennifer Murray, Ashley Brown-Jackson, Loretta Chaudhary, Aasma Posencheg, Michael A. Foglia, Elizabeth E. |
author_sort | Herrick, Heidi M. |
collection | PubMed |
description | Despite recommendations promoting noninvasive delivery room (DR) ventilation, local historical preterm DR noninvasive ventilation rates were low (50%−64%). Project aims were to improve DR noninvasive ventilation rate in very low birth weight (VLBW) neonates (<1500 g) with a focus on decreasing DR intubations for ineffective positive pressure ventilation (PPV). METHODS: We addressed drivers for improving noninvasive ventilation and decreasing intubations for ineffective PPV through plan-do-study-act cycles. Outcome measures were intubation for ineffective PPV (defined as intubation for heart rate <100 despite ongoing PPV) and final respiratory support in the DR. Our process measure was adherence to division-wide DR-intubation guidelines. Balancing measures were maximum FiO(2) and hypothermia. We analyzed data using statistical process control charts and special cause variation rules. RESULTS: There were 139 DR intubations among 521 VLBW neonates between January 2015 and February 2020. The noninvasive ventilation rate upon intensive care nursery admission was higher than historically reported at 73% and sustained throughout the project. The intubation rate for ineffective PPV was 10% and did not change. The number of VLBW neonates between intubations for ineffective PPV increased from 6.1 to 8.0. Ten intubations did not comply with guidelines. Balancing measures were unaffected. CONCLUSIONS: Noninvasive ventilation rates were higher than historically reported and remained high. After plan-do-study-act cycles, the number of VLBW neonates between intubations for ineffective PPV increased without impacting balancing measures. Our data demonstrate that effective ventilation (heart rate > 100) using noninvasive support is possible in up to 90% of VLBW infants but requires ongoing PPV training. |
format | Online Article Text |
id | pubmed-9345641 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-93456412022-08-03 Decreasing Intubation for Ineffective Ventilation after Birth for Very Low Birth Weight Neonates Herrick, Heidi M. Weinberg, Danielle D. James, Jennifer Murray, Ashley Brown-Jackson, Loretta Chaudhary, Aasma Posencheg, Michael A. Foglia, Elizabeth E. Pediatr Qual Saf Individual QI projects from single institutions Despite recommendations promoting noninvasive delivery room (DR) ventilation, local historical preterm DR noninvasive ventilation rates were low (50%−64%). Project aims were to improve DR noninvasive ventilation rate in very low birth weight (VLBW) neonates (<1500 g) with a focus on decreasing DR intubations for ineffective positive pressure ventilation (PPV). METHODS: We addressed drivers for improving noninvasive ventilation and decreasing intubations for ineffective PPV through plan-do-study-act cycles. Outcome measures were intubation for ineffective PPV (defined as intubation for heart rate <100 despite ongoing PPV) and final respiratory support in the DR. Our process measure was adherence to division-wide DR-intubation guidelines. Balancing measures were maximum FiO(2) and hypothermia. We analyzed data using statistical process control charts and special cause variation rules. RESULTS: There were 139 DR intubations among 521 VLBW neonates between January 2015 and February 2020. The noninvasive ventilation rate upon intensive care nursery admission was higher than historically reported at 73% and sustained throughout the project. The intubation rate for ineffective PPV was 10% and did not change. The number of VLBW neonates between intubations for ineffective PPV increased from 6.1 to 8.0. Ten intubations did not comply with guidelines. Balancing measures were unaffected. CONCLUSIONS: Noninvasive ventilation rates were higher than historically reported and remained high. After plan-do-study-act cycles, the number of VLBW neonates between intubations for ineffective PPV increased without impacting balancing measures. Our data demonstrate that effective ventilation (heart rate > 100) using noninvasive support is possible in up to 90% of VLBW infants but requires ongoing PPV training. Lippincott Williams & Wilkins 2022-08-01 /pmc/articles/PMC9345641/ /pubmed/35928022 http://dx.doi.org/10.1097/pq9.0000000000000580 Text en Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Individual QI projects from single institutions Herrick, Heidi M. Weinberg, Danielle D. James, Jennifer Murray, Ashley Brown-Jackson, Loretta Chaudhary, Aasma Posencheg, Michael A. Foglia, Elizabeth E. Decreasing Intubation for Ineffective Ventilation after Birth for Very Low Birth Weight Neonates |
title | Decreasing Intubation for Ineffective Ventilation after Birth for Very Low Birth Weight Neonates |
title_full | Decreasing Intubation for Ineffective Ventilation after Birth for Very Low Birth Weight Neonates |
title_fullStr | Decreasing Intubation for Ineffective Ventilation after Birth for Very Low Birth Weight Neonates |
title_full_unstemmed | Decreasing Intubation for Ineffective Ventilation after Birth for Very Low Birth Weight Neonates |
title_short | Decreasing Intubation for Ineffective Ventilation after Birth for Very Low Birth Weight Neonates |
title_sort | decreasing intubation for ineffective ventilation after birth for very low birth weight neonates |
topic | Individual QI projects from single institutions |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9345641/ https://www.ncbi.nlm.nih.gov/pubmed/35928022 http://dx.doi.org/10.1097/pq9.0000000000000580 |
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