2012 OPEN FORUM Abstracts
DEVELOPMENT AND IMPLEMENTATION OF VENTILATOR MANAGEMENT PROTOCOLS FOR THE NEONATAL INTENSIVE CARE UNIT.
Shari A. Toomey; Respiratory dept, Carilion Clinic Childrens Hospital, Roanoke, VA
Background: Mechanical ventilation in the neonate leads to lung injury, the tissues inside the lungs become inflamed and can break down causing scarring, leading to chronic lung disease. This quality study was developed to evaluate the implementation of ventilator management protocols in neonates = 28wks gestational age. The goal was to develop and implement ventilator management protocols to deliver consistency of care, decrease ventilator days, decrease length of stay (LOS), and increase rate of successful extubations. Methods: A multidisciplinary committee developed and implemented ventilator protocols in May 2010. Target population identified; 23-24wk and 25-28wk gestational age. Protocols were developed using evidence based methods along with review of guidelines and protocols from other facilities. The protocols allowed titration of ventilator settings based on blood gas ranges and clinical assessment. Per protocol, once a patient reached minimal settings and clinical assessment was satisfactory, the patient was extubated. Successful extubation was defined as maintaining adequate respiratory effort and not requiring re-intubation within 48 hours of initial extubation. Monitoring and data collection was implemented and entered into a database designed to track respiratory progress from birth to discharge. Results: In 2009, 91 patients = 28wk gestational age required mechanical ventilation, an average 19.7 ventilator days; In 2010, 70 patients = 28wk gestational age, required mechanical ventilation an average 13.1 ventilator days. In 2011, 93 patients = 28wk gestational age required mechanical ventilation an average 12.2 ventilator days. In the 23-24wk age group, 70% of patients achieved successful extubation. In the 25-28wk age group, 90% of patients achieved successful extubation. In 2009, length of stay (LOS) for the = 28 wk patient populations was 77 days. In 2010, LOS for the = 28 wk patient populations was 72 days. In 2011, LOS for the = 28 wk patient populations was 63 days. Conclusion: Implementation of ventilator management protocols resulted in a decrease in total ventilator days, decrease in LOS, and an increased rate of successful extubations. Ventilator management protocols allowed our unit to standardize care and successfully titrate our patient ventilators to help ensure successful extubation. We will continue to monitor our outcomes as we continue to address all issues in relation to mechanical ventilation. Sponsored Research - None