A Consistent Approach to Noninvasive Ventilation in a Level II Nursery

POSTER

A Consistent Approach to Noninvasive Ventilation in a Level II Nursery Wendy A. Rushton, BSN, DNP Student Contributions and expertise provided by: Project Chair Julieanne Schiefelbein, DNP; Bradley Yoder, MD; and Lonnie J. Miner, MD Early use of CPAP in neonates promotes alveolar stability, improves functional residual capacity, and can reduce the need for mechanical ventilation. Clinical guidelines reduce variation in patient management strategies and can improve patient outcomes in resource limited nurseries. Establishing failure criteria expedites escalation of respiratory support, neonatology consult, and transfer to a higher level of care. METHODS PURPOSE  Develop an evidence-based guideline to manage noninvasive ventilation in a level II nursery;  minimize lung injury  improve patient safety  reduce the need for transfer to a tertiary center  Provide lung protective strategy education  Disseminate the guideline to neonatal providers BACKGROUND  Respiratory compromise is the most common reason for admission to a neonatal care unit.  Infants born at 34 weeks or greater account for over 1/3 of total NICU admissions and significant respiratory morbidity.  There is increasing evidence for adopting a lung protective approach to managing respiratory distress in both term and preterm infants. GRAPHIC  A clinical guideline was developed based on current evidence with guidance from neonatal experts.  The completed guideline was reviewed by content experts, revised, and presented to providers at a level II nursery.  An educational program regarding lung protective strategies and use of the guideline was presented to clinicians at the implementation site. CONCLUSIONS/IMPLICATIONS  Infants requiring respiratory support in level II nurseries face substantial challenges due to limited resources.  No interface has been determined to be superior.  Skin integrity, ease of positioning, and patient comfort can be impacted by NIV interface.  Noninvasive intermittent positive pressure ventilation can be used as a strategy to avoid reintubation. METHODS