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  • Quality Improvement Article
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Decreasing early invasive mechanical ventilation exposure in preterm infants: a quality improvement initiative

Journal of Perinatology (2024)Cite this article

Subjects

Abstract

Objective

To decrease invasive mechanical ventilation exposure in the neonatal intensive care unit (NICU) in the first week of life for preterm infants with the global aim of decreasing bronchopulmonary dysplasia (BPD).

Methods

We created a quality improvement (QI) initiative to optimize early non-invasive respiratory support which launched in August 2021. Patients born at <32 weeks gestation and admitted to the NICU on non-invasive respiratory support were included.

Results

Invasive mechanical ventilation exposure decreased from 38 to 25% with evidence of special cause variation beginning in August 2022. Infants born at ≥26 weeks were most impacted, with a 50% reduction, from 34 to 17%. While BPD rates decreased, there has not yet been evidence of special cause variation.

Conclusion

Invasive mechanical ventilation exposure for infants born at <32 weeks gestation decreased following the creation of a QI initiative focused on optimization and standardization of early non-invasive respiratory support.

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Fig. 1: Key driver diagram.
Fig. 2: Invasive mechanical ventilation p-charts.

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Acknowledgements

We thank Kelly Butler, RN, Amy Roseboom, RRT, Beth Fulford, RRT, and Jaclyn Smith, RRT for their support in project education, assistance in designing project interventions, and dissemination of project updates.

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Authors and Affiliations

  1. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA

    Blair Welch, Rebecca Rose, Izlin Lien & Alana Barbato

  2. Riley Children’s Health, Indiana University Health, Indianapolis, IN, USA

    Blair Welch, Rebecca Rose, Jessica Myers, Meghan Drayton Jackson, Izlin Lien & Alana Barbato

  3. Division of Hematology and Oncology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA

    Meghan Drayton Jackson

Authors
  1. Blair Welch
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  2. Rebecca Rose
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  3. Jessica Myers
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  4. Meghan Drayton Jackson
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  5. Izlin Lien
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  6. Alana Barbato
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Contributions

Dr Welch conceptualized and designed the study, collected data, carried out the analyses, drafted the initial manuscript, and reviewed and revised the manuscript. Drs Rose and Barbato conceptualized and designed the study, supervised the data collection and analyses, drafted the initial manuscript, and reviewed and revised the manuscript. Ms Myers conceptualized and designed the study, collected data, assisted with data analysis, and reviewed and revised the manuscript. Dr Drayton Jackson designed the study, supervised data analysis, and reviewed and revised the manuscript. Dr Lien conceptualized and designed the study, supervised data collection and analysis, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Blair Welch.

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Competing interests

The authors declare no competing interests.

Ethics approval

This project was submitted to the Indiana University Institutional Review Board and deemed exempt (IRB #12007).

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Welch, B., Rose, R., Myers, J. et al. Decreasing early invasive mechanical ventilation exposure in preterm infants: a quality improvement initiative. J Perinatol (2024). https://doi.org/10.1038/s41372-024-02098-9

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  • DOI: https://doi.org/10.1038/s41372-024-02098-9

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