Document Detail


Evidence-based approach to change in clinical practice: introduction of expanded nasal continuous positive airway pressure use in an intensive care nursery.
MedLine Citation:
PMID:  12671174     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Recent studies provide evidence that nasal intermittent positive pressure ventilation (NIPPV) may stabilize the airway of extremely low birth weight infants after endotracheal extubation. The objective of this project was to introduce the use of NIPPV into a busy level 3 intensive care nursery. METHODS: This report describes the process of NIPPV introduction using a series of rapid-cycle improvement projects, as proposed by the Vermont Oxford Network. RESULTS: In the first cycle, 7 (88%) of 8 infants were successfully extubated with NIPPV after meeting criteria for reintubation on nasal continuous positive airway pressure alone. Proper positioning of the prongs in the nasopharynx was found to be an important determinant of success. In a second cycle, shorter 2.5-cm nasopharyngeal prongs were more effective than standard 4-cm prongs in 12 recently extubated infants as assessed by objective measurements and subjective nursing reports. A third cycle confirmed the acceptance of this technique in our unit and demonstrated an associated decrease in markers of chronic lung disease in extremely low birth weight infants during the 22 months after its introduction. CONCLUSION: This experience supports the role for the rapid-cycle change model in achieving effective evidence-based medical practices in a neonatal intensive care setting.
Authors:
Jodi K Jackson; Judy Vellucci; Patrice Johnson; Howard W Kilbride
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatrics     Volume:  111     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-04-02     Completed Date:  2003-04-25     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e542-7     Citation Subset:  AIM; IM    
Affiliation:
Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri 64108, USA. jjackson@cmh.edu
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MeSH Terms
Descriptor/Qualifier:
Data Collection
Evidence-Based Medicine*
Humans
Infant, Newborn
Infant, Very Low Birth Weight*
Intensive Care Units, Neonatal / organization & administration*,  standards
Intensive Care, Neonatal / organization & administration,  standards*
Medical Audit
Organizational Innovation
Patient Care Team / organization & administration
Positive-Pressure Respiration / instrumentation,  methods*
Respiratory Insufficiency / therapy*
Technology Transfer
Total Quality Management / methods
Treatment Outcome
Ventilator Weaning

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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