RESUMEN
OBJECTIVE: Collaborative quality improvement techniques were used to facilitate local quality improvement in the management of pain in infants. Several case studies are presented to highlight this process. METHODS: Twelve NICUs in the Neonatal Intensive Care Quality Improvement Collaborative 2002 focused on improving neonatal pain management and sedation practices. These centers developed and implemented evidence-based potentially better practices for pain management and sedation in neonates. The group introduced changes through plan-do-study-act cycles and tracked performance measures throughout the process. RESULTS: Strategies for implementing potentially better practices varied between centers on the basis of local characteristics. Individual centers identified barriers to implementation, developed tools for improvement, and shared their experience with the collaborative. Baseline data from the 12 sites revealed substantial opportunities for improved pain management, and local potentially better practice implementation resulted in measurable improvements in pain management at participating centers. CONCLUSIONS: The use of collaborative quality improvement techniques enhanced local quality improvement efforts and resulted in effective implementation of potentially better practices at participating centers.
Asunto(s)
Unidades de Cuidado Intensivo Neonatal/normas , Manejo del Dolor , Garantía de la Calidad de Atención de Salud , Analgesia/métodos , Analgésicos Opioides/uso terapéutico , Grupos Focales , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal/organización & administración , Evaluación de Procesos y Resultados en Atención de Salud , Dimensión del Dolor/métodos , Respiración Artificial , Sacarosa/administración & dosificación , Edulcorantes/administración & dosificación , Estados UnidosRESUMEN
BACKGROUND/PURPOSE: Liquid ventilation is a promising therapy for respiratory failure. The effects of perfluorochemical on cardiac output have not been well described. The purpose of this study was to compare cerebral blood flow (Q(CAROTID)) and cerebral metabolic rates (CMR) during conventional ventilation (CV) and partial liquid ventilation (PLV). METHODS: Five 2-week-old lambs underwent tracheostomy and central venous, aortic, and postcerebral venous catheter placement. Doppler flow probes were placed around the common ovine trunk, and the lambs underwent CV for 1 hour. Ventilation was adjusted to maintain physiologic blood gases. Pre- and postcerebral blood gas, glucose, and lactate samples were obtained every 15 minutes. Perfluorodecalin then was instilled endotracheally. The lambs underwent 1 hour of PLV with similar sampling. Data were analyzed using the Wilcoxon matched pairs test, significance at P