NICU Bedside Caregivers Sustain Process Improvement and Decrease Incidence of Bronchopulmonary Dysplasia in Infants < 30 Weeks Gestation

摘要: BACKGROUND: The objective of this study was to investigate whether a respiratory care bundle, implemented through participation in the Vermont Oxford Network-sponsored Neonatal Intensive Care Quality Improvement Collaborative (NIC/Q 2005) and primarily dependent on bedside caregivers, resulted sustained decrease incidence bronchopulmonary dysplasia (BPD) infants < 30 wk gestation. METHODS: A retrospective cohort conducted. Infants inborn between 23 29 + 6 d gestation were included. Patients with congenital heart disease, significant or lung anomalies, death before intubation excluded. Four time periods (T1–T4) identified: T1: September 1, 2002 August 31, 2004; T2: 2004 2006; T3: 2006 2008; T4: 2008 2010. RESULTS: total 1,050 included study. BPD decreased significantly T3 post-implementation bundle compared T1 (29.9% vs 51.2%, respectively; adjusted odds ratio [aOR] = 0.06 [95% CI 0.03–0.13], P .001). not into T4. There increase rate BPD-free survival discharge (53.1% 47%; aOR 1.68 1.11–2.56], .01) that also sustained. requiring O2 at 28 life versus (40.3% 69.9%, 0.12 0.07–0.20], Increases surfactant administration by 1 h caffeine use observed T4 T1, respectively. median ventilator days number noninvasive CPAP throughout period. CONCLUSIONS: In study, implementation managed nurses therapists successful increasing less invasive support consistent manner among very low birthweight single institution. However, others have failed show improvement despite process change.