Quinones Cardona Vilmaris, Byrne Emma McNell, Arthur Novisi, Young Megan, Lavery Diane, Carroll Amanda, Joshi Swosti, Kehinde Folasade, Menkiti Ogechukwu
From the Division of Neonatology, Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pa.
Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pa.
Pediatr Qual Saf. 2024 Dec 24;10(1):e780. doi: 10.1097/pq9.0000000000000780. eCollection 2025 Jan-Feb.
Although associated with respiratory morbidity, elective endotracheal intubation (ETI) for laser photocoagulation for retinopathy of prematurity (ROP) is the standard practice at our institution, with 100% of patients undergoing preoperation ETI. To mitigate this risk, we strove to reduce the percentage of infants intubated for laser photocoagulation by 30% by June 2022.
We assembled a multidisciplinary team and implemented a deep sedation guideline utilizing dexmedetomidine, fentanyl, and midazolam with noninvasive ventilation support for laser photocoagulation in January 2020. Outcome, process, and balancing measures tracked the efficacy and safety of the quality improvement project.
We reduced the percentage of infants requiring intubation for laser photocoagulation from 100% (8/8) to 10% (1/10). We reduced the average time to return to baseline respiratory status from 224.1 to 33.8 hours (9.3d to1.4 d). Cardiorespiratory index scores slightly increased (1 to 1.2), and pain scores remained unchanged after interventions.
A multidisciplinary team approach using a deep sedation guideline and noninvasive ventilation can safely reduce the requirement for intubation during laser photocoagulation with a faster return to baseline respiratory status.
尽管与呼吸道疾病相关，但在我们机构，对早产儿视网膜病变（ROP）进行激光光凝治疗时进行择期气管插管（ETI）是标准做法，100%的患者在术前接受ETI。为降低这种风险，我们力争到2022年6月将因激光光凝治疗而插管的婴儿比例降低30%。
2020年1月，我们组建了一个多学科团队，并实施了一项深度镇静指南，使用右美托咪定、芬太尼和咪达唑仑，并在激光光凝治疗时提供无创通气支持。结果、过程和平衡措施跟踪了质量改进项目的有效性和安全性。
我们将因激光光凝治疗而需要插管的婴儿比例从100%（8/8）降至10%（1/10）。我们将恢复到基线呼吸状态的平均时间从224.1小时缩短至33.8小时（9.3天至1.4天）。干预后心肺指数评分略有增加（1至1.2），疼痛评分保持不变。
采用深度镇静指南和无创通气的多学科团队方法可安全降低激光光凝治疗期间的插管需求，并能更快恢复到基线呼吸状态。
