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Published on: December 31, 2015
Reducing Intubations and Related Risks in Neonates with Retinopathy of Prematurity Undergoing Laser Photocoagulation
Vilmaris Quinones Cardona1,2, Emma McNell Byrne2, Novisi Arthur1,3
1From the Division of Neonatology, Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pa.
Insights
This study successfully reduced endotracheal intubation (ETI) for retinopathy of prematurity (ROP) laser procedures by implementing a deep sedation guideline. This improved patient recovery times and maintained safety.
Area of Science:
- Neonatal care
- Ophthalmology
- Anesthesiology
Background:
- Elective endotracheal intubation (ETI) is standard for retinopathy of prematurity (ROP) laser photocoagulation, posing respiratory risks.
- Our institution aimed to decrease ETI for ROP laser procedures by 30%.
Purpose of the Study:
- To implement and evaluate a quality improvement project reducing ETI for ROP laser photocoagulation.
- To assess the safety and efficacy of a novel deep sedation guideline.
Main Methods:
- A multidisciplinary team developed a deep sedation guideline using dexmedetomidine, fentanyl, and midazolam.
- Noninvasive ventilation support was utilized during laser photocoagulation procedures.
- Outcome, process, and balancing measures were tracked.
Main Results:
- The percentage of infants requiring intubation decreased from 100% to 10%.
- Average time to return to baseline respiratory status significantly reduced from 224.1 to 33.8 hours.
- Cardiorespiratory index scores slightly improved, and pain scores remained stable.
Conclusions:
- A multidisciplinary approach with deep sedation and noninvasive ventilation safely reduces ETI for ROP laser procedures.
- This strategy accelerates patient recovery and maintains safety during ROP treatment.
Introduction:
Although associated with respiratory morbidity, elective endotracheal intubation (ETI) for laser photocoagulation for retinopathy of prematurity (ROP) is the standard practice at our institution, with 100% of patients undergoing preoperation ETI. To mitigate this risk, we strove to reduce the percentage of infants intubated for laser photocoagulation by 30% by June 2022.
Methods:
We assembled a multidisciplinary team and implemented a deep sedation guideline utilizing dexmedetomidine, fentanyl, and midazolam with noninvasive ventilation support for laser photocoagulation in January 2020. Outcome, process, and balancing measures tracked the efficacy and safety of the quality improvement project.
Results:
We reduced the percentage of infants requiring intubation for laser photocoagulation from 100% (8/8) to 10% (1/10). We reduced the average time to return to baseline respiratory status from 224.1 to 33.8 hours (9.3d to1.4 d). Cardiorespiratory index scores slightly increased (1 to 1.2), and pain scores remained unchanged after interventions.
Conclusions:
A multidisciplinary team approach using a deep sedation guideline and noninvasive ventilation can safely reduce the requirement for intubation during laser photocoagulation with a faster return to baseline respiratory status.
