Decreasing Continuous Positive Airway Pressure Failure in Preterm Infants

医学 持续气道正压 胎龄 队列 动脉导管 机械通风 支气管肺发育不良 新生儿重症监护室 呼吸衰竭 儿科 麻醉 内科学 怀孕 遗传学 生物 阻塞性睡眠呼吸暂停
作者
Venkatakrishna Kakkilaya,Heather M. Weydig,William Smithhart,Shelly D. Renfro,Kristi M. Garcia,Cari Brown,Henry He,Sheron Wagner,Glenn C. Metoyer,L. Steven Brown,Vishal Kapadia,Rashmin C. Savani,Mambarambath A. Jaleel
出处
期刊:Pediatrics [American Academy of Pediatrics]
卷期号:148 (4) 被引量:7
标识
DOI:10.1542/peds.2020-014191
摘要

Many preterm infants stabilized on continuous positive airway pressure (CPAP) at birth require mechanical ventilation (MV) during the first 72 hours of life, which is defined as CPAP failure. Our objective was to decrease CPAP failure in infants ≤29 weeks' gestational age (GA).A quality improvement bundle named OPTISURF was implemented for infants ≤29 weeks' GA admitted on CPAP, consisting of stepwise escalation of CPAP and less invasive surfactant administration guided by fractional inspired oxygen concentration ≥0.3. The CPAP failure rate was tracked by using control charts. We compared practice and outcomes of a pre-OPTISURF cohort (January 2017 to September 2018) to a post-OPTISURF cohort (October 2018 to December 2019).Of the 216 infants ≤29 weeks' GA admitted to NICU on CPAP, 125 infants belonged to the pre-OPTISURF cohort (OSC) and 91 to the post-OSC. Compared with the pre-OSC, a higher proportion of infants in the post-OSC received CPAP 7 cm H2O within 4 hours of life (7% vs 32%; P < .01). The post-OSC also had lower rates of CPAP failure (54% vs 11%; P < .01), pneumothoraces (8% vs 1%; P < .03), need for MV (58% vs 31%; P < .01), and patent ductus arteriosus treatment (21% vs 9%; P = .02). Additionally, in a subgroup analysis, CPAP failure was lower in the post-OSC among infants 23 to 26 weeks (79% vs 27%; P < .01) and 27 to 29 weeks' GA (46% vs 3%; P < .01).Implementation of a quality improvement bundle including CPAP optimization and less invasive surfactant administration decreased CPAP failure and need for MV in preterm infants.
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