The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

IMPLEMENTING AN EVIDENCE-BASED, OUTCOMES DRIVEN, INTERDISCIPLINARY TEAM IN A RURAL, CRITICAL ACCESS HOSPITAL: THE IMPACT OF AN EARLY LUNG RECRUITMENT GUIDELINE (ELRG) IN NEWBORNS—-A PILOT STUDY

Kimberly J. Bennion1, Carri Aguiar1, Julie Ballard2, Ezra Segura1, Michele Ludlow1, MIchelle Colledge1, Jenny Chambers1, Kathie Coleman1; 1Heber Valley Medical Center Respiratory Care, Intermountain Healthcare, Heber City, UT; 2System Improvement, Primary Children’s Medical Center, Intermountain Healthcare, Salt Lake City, UT

Introduction: Heber Valley Medical Center (HVMC) is a 19-bed critical access hospital of the Intermountain Healthcare Corporation. Utah state law requires 2 licensed caregivers & physician be present at all infant deliveries. With limited nursing resources, leadership piloted the use of respiratory therapists (RT) as the second licensed caregiver specifically charged with the care of the newborn. An existing corporate ELRG was adapted in an attempt to determine if infants with respiratory distress (RD) defined as grunting &/or respiratory rate ≥70 could safely be cared for with continuous positive airway pressure (CPAP) in a rural setting. The existing corporate ELRG utilized an initial CPAP of 6, but we chose a CPAP of 4. It was our hypothesis that utilizing a lower initial CPAP pressure might prove effective in pts ≥37 weeks gestation presenting with RD.CPAP was delivered on all pts via a T-piece resuscitator. Method: Inclusion criteria were: (1) Live Birth occurring at HVMC during 2008, (2) mode of delivery,& (3) post-delivery status( admitted or transfered to another facility). There were 252 pts initially identifed, but 13 charts were unavailable leaving us with 239 pts for final review.We report that 223 (93%)of the pts were ≥37 weeks. Forty (17%)of pts were enrolled in the ELRG. Results: Outcomes are reported in Table 1. Discussion: We report only 1 (3%) of the 40 pts enrolled developed an air leak(asymptomatic pneumomediastinum with pt being discharged with mother). It is interesting to note that of the 239 pts,1 additional infant had a reported air leak but had never received positive pressure. Only 1 (3%) of the 40 pts required a CPAP pressure of 8 being performed at the request of the receiving neonatologist. Only 9 (4%) of the 239 live births required transfer to a higher level of care. Recent studies suggest that lung remodeling may be a result of untreated RD in the newborn population. It is our impression that pts with gestational age ≥ 37 weeks with RD can be safely cared for with CPAP in a rural setting if thorough education with a clearly defined ELRG, specially trained staff & standardized outcomes are used to identify & timely adapt processes. A process for implementing the ELRG to all corporate rural facilities is being defined. More studies need to be performed before conclusions can be drawn. Sponsored Research - None

Table One: 2008 HVMC Pressures & CPAP Duration for Live Births Requiring ELR

*PPV defined as Positive Pressure Ventilation requiring a peak inspiratory pressure & positive end expiratory pressure

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