Objectives

To assess respiratory care guidelines and explore variations in management of very low birth weight (VLBW) infants within a collaborative care framework. Additionally, to gather clinical leaders’ perspectives on guidelines and preferences for ventilation modalities.

Study design

Leaders from each NICU participated in a practice survey regarding the prevalence of unit clinical guidelines, and management, at many stages of care.

Results

Units have an average of 4.3 (±2.1) guidelines, of 9 topics queried. Guideline prevalence was not associated with practice or outcomes. An FiO₂ requirement of 0.3–0.4 and a CPAP of 6–7 cmH₂O, are the most common thresholds for surfactant administration, which is most often done after intubation, and followed by weaning from ventilatory support. Volume targeted ventilation is commonly used. Extubation criteria vary widely.

Conclusions

Results identify trends and areas of variation and suggest that the presence of guidelines alone is not predictive of outcome.

中文翻译：

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新英格兰 III 级和 IV 级 NICU 的新生儿呼吸护理实践

目标

评估呼吸护理指南并探索协作护理框架内极低出生体重 (VLBW) 婴儿管理的变化。此外，收集临床领导者对通气方式指南和偏好的看法。

学习规划

每个新生儿重症监护病房的领导参加了一项有关各护理阶段的单位临床指南和管理流行情况的实践调查。

结果

各单元平均有 4.3 (±2.1) 条指南，涉及 9 个主题。指南流行率与实践或结果无关。FiO ₂要求为 0.3–0.4，CPAP 为 6–7 cmH ₂ O，是表面活性剂给药最常见的阈值，通常在插管后进行，然后脱离通气支持。通常采用容量目标通气。拔管标准差异很大。

结论

结果确定了趋势和变化领域，并表明仅存在指南并不能预测结果。