BACKGROUND Excessive ventilation at rates of 30 breaths per minute (bpm) or more during cardiopulmonary resuscitation (CPR) decreases venous return and coronary perfusion pressure, leading to lower survival rates in animal models. A review of our institution's pediatric CPR data revealed that patients frequently received excessive ventilation. METHODS We designed a multifaceted quality improvement program to decrease the incidence of clinically significant hyperventilation (≥30 bpm) during pediatric CPR. The program consisted of provider education, CPR ventilation tools (ventilation reminder cards, ventilation metronome), and individual CPR team member feedback. CPR events were reviewed pre- and postintervention. The first 10 minutes of each CPR event were divided into 20 second epochs, and the ventilation rate in each epoch was measured via end-tidal carbon dioxide waveform. Individual epochs were classified as within the target ventilation range (<30 bpm) or clinically significant hyperventilation (≥30 bpm). The proportion of epochs with clinically significant hyperventilation, as well as median ventilation rates, were analyzed in the pre- and postintervention periods. RESULTS In the preintervention period (37 events, 699 epochs), 51% of CPR epochs had ventilation rates ≥30 bpm. In the postintervention period (24 events, 426 epochs), the proportion of CPR epochs with clinically significant hyperventilation decreased to 29% (P < .001). Median respiratory rates decreased from 30 bpm (interquartile range 21-36) preintervention to 21 bpm (interquartile range 12-30) postintervention (P < .001). CONCLUSIONS A quality improvement initiative grounded in improved provider education, CPR team member feedback, and tools focused on CPR ventilation rates was effective at reducing rates of clinically significant hyperventilation during pediatric CPR.

中文翻译：

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提高小儿心肺复苏期间的通气率。

背景技术在心肺复苏 (CPR) 期间以每分钟 30 次呼吸 (bpm) 或更多的速率过度通气会降低静脉回流和冠状动脉灌注压，从而导致动物模型中的存活率降低。对我们机构儿科 CPR 数据的回顾显示，患者经常接受过度通气。方法 我们设计了一个多方面的质量改进计划，以降低儿科 CPR 期间临床显着过度换气（≥30 bpm）的发生率。该计划包括提供者教育、CPR 通气工具（通气提醒卡、通气节拍器）和个人 CPR 团队成员反馈。CPR 事件在干预前和干预后进行了审查。每个 CPR 事件的前 10 分钟分为 20 秒的时期，通过呼气末二氧化碳波形测量每个时期的通气率。个别时期被分类为在目标通气范围内（<30 bpm）或临床上显着的过度换气（≥30 bpm）。在干预前和干预后分析了具有临床意义的过度换气的时期的比例以及中位换气率。结果 在干预前期间（37 个事件，699 个时期），51% 的 CPR 时期的通气率≥30 bpm。在干预后阶段（24 个事件，426 个时期），具有临床意义的过度换气的 CPR 时期的比例下降到 29%（P < .001）。中位呼吸频率从干预前的 30 bpm（四分位距 21-36）降至干预后的 21 bpm（四分位距 12-30）（P < .001）。