Reducing duration of invasive mechanical ventilation for preterm infants

Abstract

Mechanical ventilation contributes to bronchopulmonary dysplasia in preterm infants. We aimed to reduce the duration of ventilation by weaning ventilator settings within 1 h of “weanable” blood gases and extubating within 1 h of a “weanable” blood gas on “extubatable” ventilator settings. Infants born at < 32 weeks/< 1500 g were included. “Weanable” blood gases and “extubatable” ventilator settings were defined. Interventions included: a multidisciplinary BPD prevention team, extubation criteria, NICU education, a process for rapid notification of medical staff about all blood gas results, and monthly data dissemination. Extubations within 1 h of criteria increased from 64% to 88% after the dissemination of guidelines and education. The time to extubation decreased from 325 to 49 min, and the duration of intubation decreased from 8 to 3 days. However, the time for ventilator weaning did not change. Re-intubation rates did not change. Standardization of extubation led to decreased duration of mechanical ventilation.