The Science Journal of the American Association for Respiratory Care

1998 OPEN FORUM Abstracts

A CARE PATH DECREASES RESOURCE USE FOR NEONATES WITH RESPIRATORY DISTRESS SYNDROME (RDS)

Robert L. Chatburn RRT, Michele C. Walsh-Sukys MD, Patricia M. DePompei, RN, Vickey L. Moroney, RN. Rainbow Babies & Childrens Hospital. Cleveland, OH.

The purpose of this study was to determine the effects of a respiratory therapy focused care path for neonates with RDS treated in a Level III nursery. METHOD: A team of physicians, respiratory therapists, nurses and other caregivers developed a care path after a critical literature review. Consensus based indications standardized decisions for intubation, surfactant administration, aminophylline treatment, ABG analysis, extubation, CPAP, and oxygen therapy by hood. The care path encouraged patient triggered ventilation (ie, pressure controlled SIMV rather than IMV), aggressive weaning, and use of the Infant Flow CPAP system. Respiratory therapists were responsible for keeping the patient on the path, documenting therapy using an algoform (see Respir Care 1997;43:22-29) and for ventilator changes to achieve ordered target values for gas exchange. Outcome data and care path variances were tracked by a dedicated RDS care manager (registered nurse). All very low birthweight ( < 28 weeks plus < = 1,500 g) infants were eligible for care path entry. Data for a care path group were compared to a matched control group who were in the NICU before care path implementation. Demographic data, severity of illness (Score for Acute Physiology), and outcome data were compared with two-tailed, unpaired t-tests or Fisher's Exact test. Cost data were not available. Results: The study group was composed of 32 infants admitted from 1/97 to 8/97. The control group had 44 infants from 1/96 to 12/96. Compliance with care path standards was good: timely surfactant (74%), use of SIMV (67%), aminophylline (90%) CPAP (90%). Data are shown below as mean ± standard deviation:

Demographics Control Carepath p Value

birthweight (g) 885 ± 219 931 ± 202 < 0.01

gestational age (wks) 26.2 ± 1.5 26.4 ± 1.3 NS

% white 34 58 < 0.01

% male 52 68 < 0.01

severity score 17.4 ± 9.5 17.3 ± 8.8 NS

Outcomes

ventilator days 26.7 ± 16.9 20.5 ± 16.0 < 0.01

oxygen days 36.8 ± 28.8 34.0 ± 28.0 NS

hospital length of 84.5 ± 28.7 82.1 ± 22.3 < 0.05

stay (days)

CONCLUSION: A monitored care path which focused on the respiratory management of infants with RDS significantly improved outcomes. Key success factors included the use of practical data gathering forms and a care manager.

The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.

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