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Decreasing Continuous Positive Airway Pressure Failure in Preterm Infants

Venkatakrishna B Kakkilaya1, Heather M Weydig2, William E Smithhart2

  • 1Division of Neonatal-Perinatal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas venkat.kakkilaya@utsouthwestern.edu.

Pediatrics
|September 23, 2021
PubMed

Insights

A new quality improvement bundle reduced continuous positive airway pressure (CPAP) failure in preterm infants. This intervention also decreased the need for mechanical ventilation (MV) in vulnerable newborns.

Area of Science:

  • Neonatal Intensive Care
  • Pediatric Respiratory Medicine
  • Quality Improvement in Healthcare

Background:

  • Many preterm infants (≤29 weeks' gestational age) on continuous positive airway pressure (CPAP) require mechanical ventilation (MV) within 72 hours, defined as CPAP failure.
  • Reducing CPAP failure is critical for improving outcomes in extremely preterm infants.

Purpose of the Study:

  • To decrease the rate of CPAP failure in infants ≤29 weeks' gestational age (GA).
  • To evaluate the effectiveness of a quality improvement bundle on CPAP failure and associated outcomes.

Main Methods:

  • Implementation of the OPTISURF quality improvement bundle for infants ≤29 weeks' GA on CPAP.
  • The bundle included stepwise CPAP escalation and less invasive surfactant administration, guided by fractional inspired oxygen concentration.
  • Comparison of CPAP failure rates and other outcomes between pre-OPTISURF and post-OPTISURF cohorts.

Main Results:

  • The post-OPTISURF cohort showed a significant decrease in CPAP failure (54% vs 11%; P < .01).
  • Rates of pneumothoraces, need for MV, and patent ductus arteriosus treatment were also lower in the post-OPTISURF cohort.
  • Subgroup analysis confirmed reduced CPAP failure across different gestational age ranges within the preterm group.

Conclusions:

  • A quality improvement bundle effectively reduced CPAP failure and the need for mechanical ventilation in preterm infants.
  • Optimizing CPAP and employing less invasive surfactant administration are key components for improving respiratory support in neonates.
Abstract

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