Study: Mechanical ventilation protocols improve outcomes, reduce costs
Implementing five guidelines to reduce the use of mechanical ventilation for premature infants positively impacted outcomes and reduced the cost of care, according to study findings published June 13 in Pediatrics.
Mechanical ventilation can lead to ventilator-induced inflammation, scarring and potentially bronchopulmonary dysplasia, according to lead author Bernadette Levesque, MD, of the division of newborn medicine at Children’s Hospital Boston. Instead, the study recommended five care guidelines that encourage the use of a “bubble” continuous positive airway pressure (bCPAP) system, which delivers warmed, humidified oxygen in a way that inflates infant lungs more gently than mechanical ventilators.
“While they are sometimes necessary, both supplemental oxygen and mechanical ventilation are essentially toxic to premature babies’ lungs,” said Levesque. “These guidelines really present five different interventions aimed at limiting those exposures.”
The five guidelines—exclusive use of bCPAP, provision of bCPAP in the delivery room, strict intubation criteria, strict extubation criteria, and prolonged CPAP with avoidance of cannula oxygen before 35 weeks of age—were implemented in Boston's St. Elizabeth's Medical Center's Neonatal Intensive Care Unit by Children’s staff in 2007.
Researchers studied a cohort of 121 infants, 61 of whom were born before the protocol implementation of the guidelines and 60 were born after the implementation. Most of the infants were born between 26 and 33 weeks gestation, and demographics between the two analysis groups were similar, according to the study. Outborn infants and those with major congenital anomalies or major obstetric complications were excluded from the study.
Analysis showed that those treated according to the five guidelines were less likely to be intubated, need mechanical ventilation or surfactant (which can help keep a premature infant’s lungs open), according to the study. The need for supplemental oxygen decreased as well, and researchers noted a downward trend in number of children treated for BPD and low blood pressure.
Levesque et al stated that the institution of the five guidelines not only decreased the need for intubation, surfactant, mechanical ventilation, and supplemental oxygen in infants born before 33 weeks’ gestation, but also impacted measures of respiratory care and reduced hypotension. Nonpersonnel costs and nurse staffing were unchanged in both study groups, authors noted. However, equipment costs and costs associated with the use of surfactant were lower.
“We would love to see all premature babies receive the benefits of bCPAP care,” Levesque said. “We are already seeing expanded interest in these guidelines at other area hospitals, and are working with some of the hospitals that refer premature babies to us to use bCPAP as early as possible, particularly in the delivery room.”
Mechanical ventilation can lead to ventilator-induced inflammation, scarring and potentially bronchopulmonary dysplasia, according to lead author Bernadette Levesque, MD, of the division of newborn medicine at Children’s Hospital Boston. Instead, the study recommended five care guidelines that encourage the use of a “bubble” continuous positive airway pressure (bCPAP) system, which delivers warmed, humidified oxygen in a way that inflates infant lungs more gently than mechanical ventilators.
“While they are sometimes necessary, both supplemental oxygen and mechanical ventilation are essentially toxic to premature babies’ lungs,” said Levesque. “These guidelines really present five different interventions aimed at limiting those exposures.”
The five guidelines—exclusive use of bCPAP, provision of bCPAP in the delivery room, strict intubation criteria, strict extubation criteria, and prolonged CPAP with avoidance of cannula oxygen before 35 weeks of age—were implemented in Boston's St. Elizabeth's Medical Center's Neonatal Intensive Care Unit by Children’s staff in 2007.
Researchers studied a cohort of 121 infants, 61 of whom were born before the protocol implementation of the guidelines and 60 were born after the implementation. Most of the infants were born between 26 and 33 weeks gestation, and demographics between the two analysis groups were similar, according to the study. Outborn infants and those with major congenital anomalies or major obstetric complications were excluded from the study.
Analysis showed that those treated according to the five guidelines were less likely to be intubated, need mechanical ventilation or surfactant (which can help keep a premature infant’s lungs open), according to the study. The need for supplemental oxygen decreased as well, and researchers noted a downward trend in number of children treated for BPD and low blood pressure.
Levesque et al stated that the institution of the five guidelines not only decreased the need for intubation, surfactant, mechanical ventilation, and supplemental oxygen in infants born before 33 weeks’ gestation, but also impacted measures of respiratory care and reduced hypotension. Nonpersonnel costs and nurse staffing were unchanged in both study groups, authors noted. However, equipment costs and costs associated with the use of surfactant were lower.
“We would love to see all premature babies receive the benefits of bCPAP care,” Levesque said. “We are already seeing expanded interest in these guidelines at other area hospitals, and are working with some of the hospitals that refer premature babies to us to use bCPAP as early as possible, particularly in the delivery room.”