Implementing a Weaning Protocol for Noninvasive Respiratory Support in Neonates Decreases Overuse and Length of Stay.

BACKGROUND: As part of efforts to decrease length of hospital stay, a protocol for weaning noninvasive respiratory support was implemented using quality improvement methodology. The objective of this study was to determine whether protocol implementation decreased the time to wean to no respiratory support by 24 h (30% reduction) over 3 months in preterm infants 30-34 weeks gestational age. METHODS: A quality improvement project was conducted with the following outcome measures: primary outcome measured was hours to wean; secondary outcomes included duration of respiratory support, length of stay, and postmenstrual age at feeding milestones; and balance measures were duration of oxygen exposure and growth velocity. RESULTS: Data from 89 subjects were included. Following implementation, decreases were seen in time to wean (40% reduction, P < .001), length of stay (25% reduction, P = .02), and growth velocity (21% reduction, P = .02). CONCLUSIONS: Implementing a weaning protocol decreases duration of support and length of stay in infants 30-34 weeks gestational age. Weaning respiratory support more quickly may decrease growth velocity.

Effect of Transcutaneous Electrode Temperature on Accuracy and Precision of Carbon Dioxide and Oxygen Measurements in the Preterm Infants.

BACKGROUND: High electrode temperature during transcutaneous monitoring is associated with skin burns in extremely premature infants. We evaluated the accuracy and precision of CO2 and O2 measurements using lower transcutaneous electrode temperatures below 42°C. METHODS: We enrolled 20 neonates. Two transcutaneous monitors were placed simultaneously on each neonate, with one electrode maintained at 42°C and the other randomized to temperatures of 38, 39, 40, 41, and 42°C. Arterial blood was collected twice at each temperature. RESULTS: At the time of arterial blood sampling, values for transcutaneously measured partial pressure of CO2 (PtcCO2 ) were not significantly different among test temperatures. There was no evidence of skin burning at any temperature. For PtcCO2 , Bland-Altman analyses of all test temperatures versus 42°C showed good precision and low bias. Transcutaneously measured partial pressure of O2 (PtcO2 ) values trended arterial values but had large negative bias. CONCLUSION: Transcutaneous electrode temperatures as low as 38°C allow an assessment of PtcCO2 as accurate as that with electrodes at 42°C.