Changes in Inhaled Nitric Oxide Use Across ICUs After Implementation of a Standard Pathway.

IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE
Pediatric Critical Care Medicine Pub Date : 2024-08-01 Epub Date: 2024-05-24 DOI:10.1097/PCC.0000000000003544
Monique Radman, John McGuire, Paul Sharek, Harris Baden, Andy Koth, Robert DiGeronimo, Darren Migita, Dwight Barry, James B Johnson, Lori Rutman, Surabhi Vora
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引用次数: 0

Abstract

Objectives: Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator. It is expensive, frequently used, and not without risk. There is limited evidence supporting a standard approach to initiation and weaning. Our objective was to optimize the use of iNO in the cardiac ICU (CICU), PICU, and neonatal ICU (NICU) by establishing a standard approach to iNO utilization.

Design: A quality improvement study using a prospective cohort design with historical controls.

Setting: Four hundred seven-bed free standing quaternary care academic children's hospital.

Patients: All patients on iNO in the CICU, PICU, and NICU from January 1, 2017 to December 31, 2022.

Interventions: Unit-specific standard approaches to iNO initiation and weaning.

Measurements and main results: Sixteen thousand eighty-seven patients were admitted to the CICU, PICU, and NICU with 9343 in the pre-iNO pathway era (January 1, 2017 to June 30, 2020) and 6744 in the postpathway era (July 1, 2020 to December 31, 2022). We found a decrease in the percentage of CICU patients initiated on iNO from 17.8% to 11.8% after implementation of the iNO utilization pathway. We did not observe a change in iNO utilization between the pre- and post-iNO pathway eras in either the PICU or NICU. Based on these data, we estimate 564 total days of iNO (-24%) were saved over 24 months in association with the standard pathway in the CICU, with associated cost savings.

Conclusions: Implementation of a standard pathway for iNO use was associated with a statistically discernible reduction in total iNO usage in the CICU, but no change in iNO use in the NICU and PICU. These differential results likely occurred because of multiple contextual factors in each care setting.

实施标准路径后重症监护病房吸入一氧化氮使用量的变化。
目的:吸入一氧化氮(iNO)是一种选择性肺血管扩张剂。它价格昂贵,使用频繁,而且并非没有风险。支持启动和断奶标准方法的证据有限。我们的目标是通过建立 iNO 使用的标准方法,优化 iNO 在心脏重症监护病房 (CICU)、重症监护病房 (PICU) 和新生儿重症监护病房 (NICU) 的使用:设计:采用前瞻性队列设计和历史对照的质量改进研究:环境:拥有四百七十张床位的独立四级儿童学术医院:患者:2017 年 1 月 1 日至 2022 年 12 月 31 日期间在 CICU、PICU 和 NICU 使用 iNO 的所有患者:测量和主要结果:CICU、PICU和NICU共收治了1687名患者,其中9343人在iNO路径前(2017年1月1日至2020年6月30日),6744人在路径后(2020年7月1日至2022年12月31日)。我们发现,在实施 iNO 使用路径后,CICU 患者开始使用 iNO 的比例从 17.8% 降至 11.8%。我们没有观察到 iNO 使用途径实施前和实施后 PICU 或 NICU 中 iNO 使用率的变化。根据这些数据,我们估计在 CICU 实施标准路径后,24 个月内共节省了 564 天的 iNO(-24%),并节省了相关费用:结论:采用标准路径使用 iNO,CICU 中 iNO 的总使用量在统计学上有明显减少,但 NICU 和 PICU 中 iNO 的使用量没有变化。这些不同的结果很可能是由于每个护理环境的多种背景因素造成的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Pediatric Critical Care Medicine
Pediatric Critical Care Medicine 医学-危重病医学
CiteScore
7.40
自引率
14.60%
发文量
991
审稿时长
3-8 weeks
期刊介绍: Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.
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