PEDIATRICS Vol. 123 No. 6 June 2009, pp. 1534-1540 (doi:10.1542/peds.2008-1279)
ARTICLE |
Bubble Continuous Positive Airway Pressure, A Potentially Better Practice, Reduces the Use of Mechanical Ventilation Among Very Low Birth Weight Infants With Respiratory Distress Syndrome
a Exempla St Joseph Hospital, Denver, Colorado
b Department of Neonatology, Colorado Permanente Medical Group, Denver, Colorado
OBJECTIVE. The purpose of this work was to assess a quality improvement initiative to implement a potentially better practice, bubble continuous positive airway pressure, to reduce bronchopulmonary dysplasia and improve other pulmonary outcomes among very low birth weight infants with respiratory distress syndrome.
METHODS. An initiative to implement the use of bubble continuous positive airway pressure is described that was based on the adoption of habits for change, collaborative learning, evidence-based practice, and process development. To assess the efficacy of this intervention, very low birth weight infants with respiratory distress syndrome born after implementation of bubble continuous positive airway pressure use (period 2: March 1, 2005, to October 4, 2007; N = 126) were compared with historical controls born during a previous period of ventilator use (period 1: January 1, 2003, to February 28, 2005; N = 88). Infants at both time periods were similar with respect to characteristics and aspects of perinatal care. Pulmonary outcomes compared for the 2 time periods included receipt of mechanical ventilation, duration of mechanical ventilation, pneumothoraces, and incidence of bronchopulmonary dysplasia. Nonpulmonary outcomes were also compared.
RESULTS. The use of mechanical ventilation declined during period 2. The mean duration (+ SD) of conventional ventilation during period 2 was shorter than during period 1 (3.08 + 6.17 vs 5.25 + 8.16 days), and fewer infants during period 2 required conventional ventilation for >6 days compared with those in period 1 (13.6% vs 26.3%). In regression models, the effect of period 2 persisted after controlling for other predictors of duration of conventional ventilation. There were no significant differences in other pulmonary or nonpulmonary outcomes, with the exception of mild retinopathy of prematurity (stage I or II), which was more common during period 2. The enhanced odds of retinopathy of prematurity persisted after controlling for other known predictors of this condition.
CONCLUSION. Among very low birth weight infants with respiratory distress syndrome, the use of bubble continuous positive airway pressure is a potentially better practice that may reduce the use of mechanical ventilation. Although an increase in retinopathy of prematurity was observed in our population, carefully designed randomized, controlled trials will be required to more accurately address the potential risks and benefits of this therapy.
Key Words: health care quality assurance • premature infant • bronchopulmonary dysplasia
Abbreviations: VLBW—very low birth weight • BPD—bronchopulmonary dysplasia • CPAP—continuous positive airway pressure • NCPAP—nasal continuous positive airway pressure • CCPAP—conventional continuous positive airway pressure • BCPAP—bubble continuous positive airway pressure • PBP—potentially better practice • RDS—respiratory distress syndrome • CAT—critically appraised topic • PDSA—plan-do-study-act • CV—conventional ventilation • aOR—adjusted odds ratio • CI—confidence interval • ROP—retinopathy of prematurity • IUGR—intrauterine growth restriction
Accepted Sep 17, 2008.
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