Decreasing Chronic Lung Disease: It Begins With Transport

Background: Non-invasive ventilator strategies help decrease the incidence of chronic lung disease (CLD) in the neonate. Respiratory compromise in infants born at hospitals without a Neonatal Intensive Care Unit (NICU) require transport. Many infants are sedated and intubated for transport due to lack of tested and approved non-invasive devices for transport. SMART Aim: By January 2013, implementation of safe, effective, and laboratory tested non-invasive ventilator strategies will be developed and implemented with the goal of reducing the percentage of infants requiring intubation for transport. Setting: Our NICU is a 71 bed Level 3 NICU that services a 100-mile radius extending throughout the greater metropolitan area. Our Transport Team conducts 220 neonatal ground transports annually. Mechanisms: Many centers use sedation and intubation as the primary modality for transporting infants with respiratory distress. Solutions exist that utilize non-invasive techniques outside the manufacturer recommendations or have failed to be tested in a simulated environment. By establishing evidence based, best practice for our transport team, our goal is to design a non-invasive respiratory strategy for transport. Methods: Infants requiring mechanical respiratory support were enrolled and then separated into patients requiring intubation versus those managed non-invasively. Non-invasive strategies were high frequency, nasal continuous positive airway pressure (HFNCPAP), non-invasive positive pressure ventilation (NIPPV) or traditional nasal continuous positive airway pressure (NCPAP). All team members underwent extensive classroom and laboratory training. Subsequent competency training occurred monthly for the first 6 months, then annually. A field guide to the protocol was developed and placed in the supply bags. Measures: 1. Total Number of Transports. 2. Total Number requiring mechanical ventilation. 3. Total Number Intubated. 4. Total Number Non-Invasive. 5. SpO2 & FiO2, start and end of transport Balancing Measures: 1. Referring center mode of mechanical ventilation 2. Acute versus Chronic disease state Results/Conclusions: For 2013, 51 intubated - 9 non-invasive (15%); for 2014, 56 intubated - 16 non-invasive (22.2%); for 2015, 68 intubated - 32 non-invasive (32%); for 2016, 42 intubated - 49 non-invasive (54%); for 2017, 44 intubated - 37 non-invasive (46%). For non-invasive group, the mean FiO2 was 0.4 at start versus 0.33 at completion; the SpO2 was 94.9% at