Department of Pediatrics, Division of Developmental Pediatrics, University of Alberta, Edmonton, AB, Canada.
Department of Pediatrics, Division of Developmental Pediatrics, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada.
Pediatr Crit Care Med. 2019 Apr;20(4):350-356. doi: 10.1097/PCC.0000000000001807.
To reduce bilateral delayed-onset progressive sensory permanent hearing loss using a systems-wide quality improvement project with adherence to best practice for the administration of furosemide.
Prospective cohort study with regular audiologic follow-up assessment of survivors both before and after a 2007-2008 quality improvement practice change.
The referral center in Western Canada for complex cardiac surgery, with comprehensive multidisciplinary follow-up by the Complex Pediatric Therapies Follow-up Program.
All consecutive patients having single-ventricle palliative cardiac surgery at age 6 weeks old or younger.
A 2007-2008 quality improvement practice change consisted of a Parenteral Drug Monograph revision indicating slow IV administration of furosemide, an educational program, and an evaluation.
The outcome measure was the prevalence of permanent hearing loss by 4 years old. Firth multiple logistic regression compared pre (1996-2008) to post (2008-2012) practice change occurrence of permanent hearing loss, adjusting for confounding variables, including all hospital days, extracorporeal membrane oxygenation, cardiopulmonary bypass time, age at first surgery, dialysis, and sepsis. From 1996 to 2012, 259 infants had single-ventricle palliative surgery at age 6 weeks old or younger, with 173 (64%) surviving to age 4 years. Of survivors, 106 (61%) were male, age at surgery was 11.6 days (9.0 d), and total hospitalization days by age 4 years were 64 (42); 18 (10%) had cardiopulmonary resuscitation and 38 (22%) had sepsis at any time. All 173 (100%) had 4-year follow-up. Pre- to postpractice change permanent hearing loss dropped from 17/100 (17%) to 0/73 (0%) of survivors. On Firth multiple logistic regression, the only variable statistically associated with permanent hearing loss was the pre- to postpractice change time period (odds ratio, 0.03; 95% CI, 0-0.35; p = 0.001).
A practice change to ensure slow IV administration of furosemide eliminated permanent hearing loss. Centers caring for critically ill infants, particularly those with single-ventricle anatomy or hypoxia, should review their drug administration guidelines and adhere to best practice for administration of IV furosemide.
通过一项系统范围的质量改进项目，遵循呋塞米给药的最佳实践，减少双侧迟发性进行性感觉永久性听力损失。
前瞻性队列研究，对幸存者进行定期听力随访评估，包括 2007-2008 年质量改进实践改变前后。
加拿大西部的复杂心脏手术转诊中心，由复杂儿科治疗随访计划进行全面的多学科随访。
所有在 6 周龄或更小年龄接受单心室姑息性心脏手术的连续患者。
2007-2008 年的质量改进实践改变包括修订《静脉药物专论》，指示缓慢静脉注射呋塞米，开展教育计划，并进行评估。
结局测量是 4 岁时永久性听力损失的患病率。费尔思多项逻辑回归比较了实践改变前后（1996-2008 年和 2008-2012 年）永久性听力损失的发生情况，调整了混杂变量，包括所有住院天数、体外膜氧合、体外循环时间、首次手术年龄、透析和败血症。1996 年至 2012 年，259 名婴儿在 6 周龄或更小年龄接受了单心室姑息性手术，其中 173 名（64%）存活至 4 岁。在幸存者中，106 名（61%）为男性，手术时年龄为 11.6 天（9.0d），4 岁时的总住院天数为 64（42）天；18 名（10%）有心肺复苏，38 名（22%）有任何时间的败血症。所有 173 名（100%）均进行了 4 年随访。实践改变前，永久性听力损失从 100 名中的 17 名（17%）降至幸存者中的 73 名中的 0 名（0%）。在费尔思多项逻辑回归中，唯一与永久性听力损失相关的变量是实践改变前后的时间段（比值比，0.03；95%置信区间，0-0.35；p = 0.001）。
一项确保缓慢静脉注射呋塞米的实践改变消除了永久性听力损失。照顾重症婴儿的中心，特别是那些具有单心室解剖结构或缺氧的婴儿，应审查其药物管理指南，并遵守静脉注射呋塞米的最佳实践。
