Abstract
Objectives
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.
Methods
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.
Results
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.
Conclusions
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.
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AP, JS: Conception of work, acquisition, analysis, interpretation of data, and drafting the work; RL, SKK: Conception of work, interpretation of data, and revising the work; All authors have approved the final version and agreed to accountability for accuracy of work. SKK will act as the guarantor for this paper.
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Institutional ethical clearance was taken vide letter number IECPG-2/22.04.2019 dated 29 April 2019 from Ethics committee for PG research, AIIMS, New Delhi. The IEC gave waiver of consent.
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Pathania, A., Sankar, J., Lodha, R. et al. Quality Improvement Initiative to Improve Initiation and Acceptability of Noninvasive Ventilation in Critically Ill Children. Indian J Pediatr 89, 1209–1215 (2022). https://doi.org/10.1007/s12098-022-04164-6
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DOI: https://doi.org/10.1007/s12098-022-04164-6