Reducing NICU ventilator days by preventing fluid overload with the CAN-U-P-LOTS standardized bundle

Area of Science:

• Neonatal critical care
• Pediatric quality improvement
• Fluid management in infants

Background:

• Fluid overload is a significant concern in critically ill neonates and infants.
• It is associated with increased ventilation duration, prolonged hospital stays, and higher mortality rates.

Purpose of the Study:

• To evaluate the impact of a fluid overload prevention bundle on clinical outcomes in critically ill infants.
• To assess changes in ventilator-free days, oxygen-free days, and Neonatal Intensive Care Unit (NICU) length of stay.

Main Methods:

• A quality improvement study comparing pre-intervention (211 infants) and post-implementation (218 infants) data.
• Implementation of a multi-component bundle (CAN-U-P-LOTS) aimed at preventing fluid overload for conditions like sepsis, necrotizing enterocolitis, and acute kidney injury.
• Analysis focused on ventilator-free days, oxygen-free days, and NICU length of stay.

Main Results:

• A statistically significant increase in the percentage of ventilator-free days (67% vs. 56%) and oxygen-free days was observed post-bundle implementation (p < 0.001).
• The study demonstrated a reduction in overall NICU length of stay.
• Special cause variation indicated a positive impact coinciding with bundle introduction.

Conclusions:

• The fluid overload prevention bundle effectively improved key clinical outcomes in critically ill infants.
• The findings suggest that this bundle is associated with increased ventilator-free and oxygen-free days and a shorter NICU stay.
• Further research is warranted to validate these results in diverse populations.