Di Genova Tanya, Sperling Christina, Gionfriddo Ashley, Da Silva Zelia, Davidson Leanne, Macartney Jason, Finelli Michael, Jankov Robert P, Laussen Peter C
Division of Critical Care Medicine, Montreal Children's Hospital, Montreal, Québec, Canada (Dr Di Genova); and Departments of Respiratory Therapy (Mss Sperling and Gionfriddo and Mr Macartney) and Critical Care Medicine (Dr Laussen) and Division of Neonatology (Mss Da Silva and Davidson, Mr Finelli, and Dr Jankov), The Hospital for Sick Children, Toronto, Ontario, Canada.
Qual Manag Health Care. 2018 Apr/Jun;27(2):74-80. doi: 10.1097/QMH.0000000000000167.
Inhaled nitric oxide (iNO) is a pulmonary vasodilator that is approved for use in term and near-term neonates with hypoxic respiratory failure associated with evidence of pulmonary hypertension. However, it is commonly used in infants and children to treat a variety of other cardiopulmonary diseases associated with pulmonary hypertension and hypoxic respiratory failure. In critically ill children, iNO therapy may be continued for a prolonged period, and this increases the risk for adverse consequences including toxicity and unnecessary costs. We implemented an iNO Stewardship Program with the aim of improving adherence to guidelines and reducing unnecessary iNO utilization.
Between April 1, 2011, and March 31, 2015, a before and after cohort study was conducted at The Hospital for Sick Children. Prospective iNO usage and outcome variables in the poststewardship period were examined.
Patient characteristics and outcomes were similar before and after stewardship implementation. The number of iNO therapy courses were also similar in the before and after period. Inhaled nitric oxide utilization in the pediatric intensive care unit and the cardiac critical care unit decreased from 15 765 hours in the prestewardship period (April 2011 to March 2013) to 10 342 hours in the poststewardship period (April 2013 to March 2015), with significant improvement in adherence to the iNO guideline and a small decrease in expenditure (3%).
Implementation of the iNO Stewardship was successful at reducing overall iNO utilization. This quality improvement initiative helped us optimize practice and subsequently expand the methodology to inform the clinical indication for iNO.
吸入一氧化氮（iNO）是一种肺血管扩张剂，已被批准用于患有与肺动脉高压相关的低氧性呼吸衰竭的足月儿和近足月儿。然而，它常用于婴儿和儿童，以治疗与肺动脉高压和低氧性呼吸衰竭相关的各种其他心肺疾病。在危重症儿童中，iNO治疗可能会持续较长时间，这增加了包括毒性和不必要费用在内的不良后果的风险。我们实施了一项iNO管理计划，旨在提高对指南的依从性并减少不必要的iNO使用。
2011年4月1日至2015年3月31日期间，在病童医院进行了一项前后队列研究。检查了管理期后的前瞻性iNO使用情况和结果变量。
实施管理前后的患者特征和结果相似。iNO治疗疗程的数量在前后两个时期也相似。儿科重症监护病房和心脏重症监护病房的吸入一氧化氮使用时间从管理前期（2011年4月至2013年3月）的15765小时降至管理后期（2013年4月至2015年3月）的10342小时，对iNO指南的依从性有显著改善，支出略有下降（3%）。
iNO管理计划的实施成功降低了iNO的总体使用量。这项质量改进举措帮助我们优化了实践，并随后扩展了方法，以告知iNO的临床适应症。
