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Implementing Volume-targeted Ventilation to Decrease Hypocarbia in Extremely Low Birth Weight Infants during the
Uduak S Akpan1, Sunny Patel2, Paige Driver1
1Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, N.C.
Insights
Volume-targeted ventilation (VTV) did not reduce hypocarbia in extremely low birth weight neonates. While VTV use increased, hypocarbia rates remained similar, though it did lead to earlier extubation.
Area of Science:
- Neonatal Intensive Care
- Respiratory Support
- Quality Improvement
Background:
- Hypocarbia in neonates is linked to poor neurodevelopmental outcomes.
- Extremely low birth weight (ELBW) neonates experience high rates of hypocarbia.
- Volume-targeted ventilation (VTV) may reduce hypocarbia and respiratory morbidities.
Purpose of the Study:
- To decrease the incidence of hypocarbia in ELBW neonates by 50% within the first week of life.
- Implement VTV as the primary ventilation mode for eligible neonates.
- Enhance staff knowledge regarding hypocarbia management.
Main Methods:
- Quality improvement project in a Neonatal Intensive Care Unit.
- Interventions included VTV for neonates <28 weeks gestation or ELBW and staff education.
- Data collected over baseline (May-Aug 2016) and postintervention (12 months from Oct 2016) periods.
Main Results:
- VTV use increased from 39% to 65% postintervention.
- Hypocarbia incidence did not decrease (57% vs. 64%).
- VTV group showed decreased blood gas sampling and earlier extubation (P=0.002, P=0.046).
Conclusions:
- Increased VTV use did not reduce hypocarbia in ELBW neonates during the first week of life.
- VTV was observed to be safe in this population.
- VTV use was associated with other beneficial outcomes like earlier extubation.
Abstract:
Hypocarbia in neonates increases the risk of poor neurodevelopmental outcomes. Volume-targeted ventilation (VTV) is associated with decreased hypocarbia and other respiratory morbidities. We noticed a high incidence of hypocarbia in extremely low birth weight (ELBW; <1,000 g) neonates in our Neonatal Intensive Care Unit. Thus, we undertook a quality improvement project to decrease the incidence of hypocarbia (the occurrence of PCO2 < 35 mm Hg) in ELBW neonates during the first week of life by 50% over 1 year.
Methods:
Our major interventions were employing VTV as the primary mode of mechanical ventilation in neonates less than 28 weeks of gestation or ELBW at birth and increasing staff knowledge regarding hypocarbia. The baseline period spanned May-August 2016. We implemented the interventions in October 2016 and tracked the use of VTV and the incidence of hypocarbia during the first week of life for 12 months.
Results:
We analyzed data on 28 and 77 patients in the baseline and postintervention periods, respectively. The use of VTV increased from 39% to 65%. However, the incidence of hypocarbia was not reduced (57% preintervention vs. 64% postintervention). In the postintervention cohort, the incidence of hypocarbia was comparable between VTV and other modes (60% vs. 70%; 95% confidence interval: -32%, 12%; P = 0.367), but we noted decreased blood gas sampling and earlier extubation in the VTV group (P = 0.002 and P = 0.046, respectively).
Conclusions:
Successfully increasing VTV in our Neonatal Intensive Care Unit did not decrease hypocarbia during the first week of life. However, we observed the safety of VTV and obtained other desirable results.
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