Ahearn Joshua, Panda Malavika, Carlisle Hazel, Chaudhari Tejasvi
Australian National University Medical School, Canberra, Australian Capital Territory, Australia.
Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Woden, Australian Capital Territory, Australia.
J Paediatr Child Health. 2020 Feb;56(2):265-271. doi: 10.1111/jpc.14580. Epub 2019 Jul 31.
Inhaled nitric oxide (iNO) is the most common, although expensive, therapy for persistent pulmonary hypertension of the newborn and hypoxaemic respiratory failure. With significant variation in iNO delivery practices amongst clinicians, this study aimed to assess the effectiveness of a stewardship programme in increasing clinician compliance with revised, standardised protocols and to measure the impact of compliance on iNO therapy use.
Initiation and weaning protocols for iNO were introduced to the neonatal intensive care unit at The Centenary Hospital on 01 March 2016. A 2-year stewardship programme was utilised to assess protocol compliance and the resulting iNO usage impacts were measured. A combined retrospective and prospective study from 1 March 2014 to 28 February 2018 was conducted to compare the patterns of iNO utilisation between the pre- and post-stewardship cohorts.
The pre-stewardship cohort incorporated 18 neonates, receiving 19 iNO treatment episodes, and 18 neonates, receiving 21 iNO treatment episodes, in the post-stewardship cohort. No significant difference in patient demographics was determined. Compliance with the protocols improved from 61% in year 1 to 88% in year 2 of the stewardship programme. Significant reductions were observed in median total hours of iNO therapy per patient (P = 0.0014) and in median time from therapy initiation to initial wean (P < 0.0001). The cost of iNO therapy reduced 52% during the stewardship programme with no increase in adverse patient outcomes.
An iNO stewardship programme could be safely implemented in any NICU leading to increased protocol compliance with a beneficial reduction in iNO usage and cost.
吸入一氧化氮（iNO）是治疗新生儿持续性肺动脉高压和低氧性呼吸衰竭最常用的方法，尽管费用昂贵。由于临床医生在iNO给药方法上存在显著差异，本研究旨在评估管理计划在提高临床医生对修订后的标准化方案的依从性方面的有效性，并衡量依从性对iNO治疗使用的影响。
2016年3月1日，iNO的启动和撤机方案被引入百年医院的新生儿重症监护病房。采用为期2年的管理计划来评估方案依从性，并衡量由此产生的iNO使用影响。对2014年3月1日至2018年2月28日进行了一项回顾性和前瞻性相结合的研究，以比较管理前和管理后队列之间的iNO使用模式。
管理前队列包括18例新生儿，接受19次iNO治疗；管理后队列包括18例新生儿，接受21次iNO治疗。患者人口统计学特征无显著差异。管理计划第1年的方案依从性从61%提高到了第2年的88%。观察到每位患者iNO治疗的总小时数中位数显著减少（P = 0.0014），从治疗开始到首次撤机的时间中位数也显著减少（P < 0.0001）。在管理计划期间，iNO治疗费用降低了52%，且患者不良结局未增加。
iNO管理计划可在任何新生儿重症监护病房安全实施，从而提高方案依从性，同时有益地减少iNO的使用和成本。
