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Chronic Lung DiseaseInterventions
N. SinghalUniversity of Calgary
November 2006
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Outline
• Process
• Interventions proposed– Infection – K. Aziz– CLD – N. Singhal
• Interventions implemented– Infection – K. Aziz– CLD – N. Singhal
• Future directions – K. Aziz
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Review Process
• Cochrane reviews
• Systematic reviews
• Informal reviews
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CLD Group Interventions
• Process– Experts selected topics
– Training provided for literature review
– Each centre given ONE topic to review
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Review Process
• Cochrane reviews
• Systematic reviews
• Informal reviews
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• Meeting of all centre/experts to discuss areas for improvement
• Generated list of interventions
Process cont’d
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Interventions Proposed
• Antenatal
– Treat urea plasma with erythromycin
– Antenatal steroids
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Interventions Proposed
• Resuscitation
– Early within one hour prophylactic surfactant <28 weeks or <1250 g.
– Diminish hand ventilation
– Decrease 100% oxygen exposure
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Interventions Proposed
• CPAP
– Early CPAP for babies in supplemental oxygen
– Long term CPAP
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Interventions Proposed
• Ventilation–Early use of
HFV
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Interventions Proposed
• Normocarbia
• Avoid hypocarbia
• PaC02 40-55 mm of Hg
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Interventions Proposed
• Saturation targets
• Saturation targets
• > 88 to < 94 ? 93
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Interventions Proposed
• Nutrition/Fluids– Calories– Decrease fluid use– High dose Vitamin A
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Interventions Proposed
• Environment– Pain– Massage– Noise– NIDCAP
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CLD Interventions Implemented
• Antenatal:-Antibiotics
-Expectant arrangement of PROM
-Antenatal steroids
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CLD Interventions Implemented
• Resuscitation– Surfactant within 30 minutes– Avoid hand ventilation– Ventilation delivery room– Only Laerdel bags with PEEP– Blended gases
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CLD Interventions Implemented
• Ventilation– Early HVF – not done– Assist control and volume guarantee
–Not done specifically
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CLD Interventions Implemented
• Normocarbia– PaC02 – 45-55 mm of Hg
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CLD Interventions Implemented
• Saturation targets– Sat alarm limits 85-95%– Goal 88-92%
• Physician orders oxygen as drug
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CLD Interventions Implemented
• Nutrition/Fluids– ↓ TFI < 32 weeks first few days– TPN within 24 hours– TPN within 4 hours
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CLD Interventions Implemented
• Environment – Renovations to unit– ↓ sound levels
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CLD Interventions Implemented
• Others:– Comment card for parents– Avoid re-intubation with CPAP– Perinatal referral policies
Early CPAP – EPIC PDSA Cycle # 4
> 27 weeks and < 34 weeks
Respiratory Distress? (based on clinical
judgment)
Intubate, BLES transfer to NICU (*may be given in NICU after
transfer)
Stabilize then transfer to NICU
Extubate to CPAP if FiO2 <.4 at 2 to 4 hours of age and if
clinically stable
Develops respiratory distress?
Intubate, BLES
Extubate to CPAP if FiO2 <.4 (no time frame)
Routine management***
Routine management***
Routine management***
If > 27 weeks, had HMD and on supplemental FiO2 in first 24 hours of life should be on CPAP
*** wean from CPAP as per clinical indications
No
Yes
Yes No
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Thank you
