The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

QUALITY IMPROVEMENT PROJECT: TOLERABILITY AND EFFICACY OF THREE DEVISES USED FOR EARLY LUNG RECRUITMENT.

Daniel D. Woodhead, Vicki L. Baer, Diane K. Lambert, Robert D. Christensen; McKay-Dee, Ogden, UT

Background. Admission to a NICU for endotracheal intubation and mechanical ventilation can sometimes be averted by applying early lung recruitment during the transition period. Various modalities have been used to accomplish this, each with advantages and disadvantages. We sought to compare both patient tolerability and efficacy of three such modalities, using a quality improvement project; the basic bubble nasal cannula (NC), the Fisher & Paykel (F&P) 850 heated nasal cannula system, and the Precision Flow (PF) system from Vapotherm. Methods. The project occurred between June 2009 and March 2010. Patients >35.0 weeks gestation were eligible if, in the first 30 min after birth, they had at least three of the following signs; 1) grunting and/or retractions, 2) respiratory rate >60/min, 3) breath sounds decreased but equal, 4) FiO2 >30%. Early lung recruitment was performed for 90 min according to protocol, on eligible patients, using one of the three test devises. Assignment to a devise was pre-determined. Study data were collected prospectively by a NICU respiratory therapist or nurse. Tolerability was judged using a scoring system of back-arching and arm-stiffing. Efficacy was judged by whether NICU admission and intubation were averted, and by whether the patient required “rescue” by changing from the failed original devise to an alternative devise. Results. Early lung recruitment was performed using the NC in 18 neonates, the F&P in 23, and the PF in 17. Demographic and clinical features of those in the three groups were not statistically different. Tolerability scores were lowest (best) for the PF (0.0±0.2), intermediate for the F&P (1.7±1.6) and poorest for the NC (2.8±1.2) (P < 0.001 for PF vs. others). Efficacy measures were as follows: NICU admission occurred in 4/17 (24%) of those treated with PF, in 7/23 (30%) of those treated with F&P, and in 8/18(44%) of those with the NC. A similar trend was seen in intubation rate among those admitted to the NICU (PF 0%, F&P 86%, NC 50%). In an attempt to avert NICU admission, 17 were switched from the original devise to another devise. Those who failed the original devise were; PF (0/17, 0%), F&P (7/23, 30%, P < 0.01 vs. PF), NC (10/18, 56% P=0.000 vs. PF). Conclusion. Of the three methods tested for early lung recruitment during the transition period, the Precision Flow had the best patient tolerability scores, the lowest failure rates, and the highest rates of averting NICU admission. Sponsored Research - Vapotherm lent us a Precision Flow machine to use in our project.