Pathania Amit, Sankar Jhuma, Lodha Rakesh, Kabra Sushil K
Department of Pediatrics, Base Hospital Delhi Cantt, New Delhi, India.
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
Indian J Pediatr. 2022 Dec;89(12):1209-1215. doi: 10.1007/s12098-022-04164-6. Epub 2022 May 25.
To evaluate if the use of a quality improvement (QI) initiative improves initiation and acceptability of noninvasive ventilation (NIV) in critically ill children with respiratory distress.
The study was carried out in 3 phases over a period of 6 mo in the pediatric intensive care unit of a tertiary care hospital in children aged 2 mo to 14 y of age. In phase 1, data were collected for 1 mo and reasons for NIV failure were identified. In phase 2, process changes like adherence to checklist, monitoring, and one-day orientation program were instituted. The plan-do-study-act (PDSA) cycle was carried out in each phase. In phase 3, which was for 2 mo, the acceptance of NIV was measured and results were compared with phase 1.
A total of 37 patients were included, 12 in phase 1 and 25 in phase 3. NIV failure was recorded in 5 (42%) and 2 (8%) patients in phase 1 and phase 3 (p = 0.025), respectively. The cause of NIV failure was intolerance to the interface in both phases. Sedation was used in 18 (72%) patients in phase 3, as compared to 2 patients in phase 1.
The use of a quality improvement initiative in the form of a protocol, checklist, and training of the treating team resulted in improved tolerance to NIV, and thereby, its success. Use of sedation may help improve tolerance to the interface and contribute to its success.
评估质量改进（QI）措施是否能提高呼吸窘迫危重症儿童无创通气（NIV）的启动率和可接受性。
该研究在一家三级医院儿科重症监护病房对2个月至14岁儿童进行，为期6个月，分3个阶段进行。在第1阶段，收集1个月的数据并确定无创通气失败的原因。在第2阶段，实施了诸如遵守检查表、监测和一日培训计划等流程改进措施。每个阶段都进行了计划-实施-研究-改进（PDSA）循环。在为期2个月的第3阶段，测量无创通气的接受情况，并将结果与第1阶段进行比较。
共纳入37例患者，第1阶段12例，第3阶段25例。第1阶段和第3阶段分别有5例（42%）和2例（8%）患者记录到无创通气失败（p = 0.025）。两个阶段无创通气失败的原因均为对接口不耐受。第3阶段18例（72%）患者使用了镇静剂，而第1阶段为2例。
以方案、检查表和对治疗团队进行培训的形式实施质量改进措施，可提高对无创通气的耐受性，从而提高其成功率。使用镇静剂可能有助于提高对接口的耐受性并促进其成功。
