Decreasing Exposure to Mechanical Ventilation in Extremely Preterm Infants

BACKGROUND AND OBJECTIVES Provider variability in mechanical ventilation weaning practices may result in prolonged invasive ventilation exposure that may contribute to the development of bronchopulmonary dysplasia (BPD) in extremely preterm infants. Our SMART aim was to reduce the proportion of infants born between 24 and 28 6/7 weeks’ gestation exposed to invasive ventilation for more than 7 days by 25% within 12 months. METHODS This was a single-center quality improvement initiative at The University of Alabama at Birmingham conducted between January 2021 and March 2023. Interventions to reduce mechanical ventilation exposure included the following: (1) establishing a consensus for invasive ventilation exposure including intubation, extubation, and reintubation, (2) development of a bedside weaning readiness tool to facilitate permissive hypercapnia, (3) empowerment of respiratory therapist facilitated weaning, and (4) the creation of a ventilation dashboard. All measures were analyzed using statistical process control charts. RESULTS The initiative included 340 infants with a median gestational age of 26 6/7 weeks (IQR, 25–28) and birth weight of 842 g (IQR, 686–1011). The baseline proportion of infants invasively ventilated for more than 7 days at baseline was 44%, which decreased to 25% following implementation of the bedside weaning readiness and communication tool. Special cause variation was also observed for rates of BPD or death, which decreased from a baseline of 55% to 40%. CONCLUSIONS In infants between 24 and 28 6/7 weeks’ gestation, systematic ventilator weaning was associated with a decrease in infants invasively ventilated for more than 7 days and a decrease in BPD or death.