Beth Israel Deaconess Medical Center, Boston, MA, USA.
Boston Medical Center, Boston, MA, USA.
J Perinatol. 2024 Sep;44(9):1291-1299. doi: 10.1038/s41372-024-01926-2. Epub 2024 Mar 11.
To assess respiratory care guidelines and explore variations in management of very low birth weight (VLBW) infants within a collaborative care framework. Additionally, to gather clinical leaders' perspectives on guidelines and preferences for ventilation modalities.
Leaders from each NICU participated in a practice survey regarding the prevalence of unit clinical guidelines, and management, at many stages of care.
Units have an average of 4.3 (±2.1) guidelines, of 9 topics queried. Guideline prevalence was not associated with practice or outcomes. An FiO requirement of 0.3-0.4 and a CPAP of 6-7 cmHO, are the most common thresholds for surfactant administration, which is most often done after intubation, and followed by weaning from ventilatory support. Volume targeted ventilation is commonly used. Extubation criteria vary widely.
Results identify trends and areas of variation and suggest that the presence of guidelines alone is not predictive of outcome.
评估呼吸治疗指南，并在协作护理框架内探讨极低出生体重（VLBW）婴儿管理的差异。此外，收集临床领导者对指南的看法以及对通气模式的偏好。
每位新生儿重症监护病房（NICU）的领导者都参与了一项实践调查，调查了单位在许多护理阶段的临床指南和管理的流行情况。
各单位平均有 4.3（±2.1）条指南，涉及 9 个主题。指南的流行率与实践或结果无关。FiO2 需求为 0.3-0.4，CPAP 为 6-7cmH2O，是表面活性剂给药的最常见阈值，最常在插管后进行，随后逐渐减少通气支持。容量目标通气法被广泛使用。拔管标准差异很大。
结果确定了趋势和差异领域，并表明指南的存在本身并不能预测结果。
