1 / 28

Chronic Lung Disease Interventions

Chronic Lung Disease Interventions. N. Singhal University of Calgary November 2006. Outline. Process Interventions proposed Infection – K. Aziz CLD – N. Singhal Interventions implemented Infection – K. Aziz CLD – N. Singhal Future directions – K. Aziz. Review Process . Cochrane reviews

tejano
Download Presentation

Chronic Lung Disease Interventions

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Chronic Lung DiseaseInterventions N. SinghalUniversity of CalgaryNovember 2006

  2. Outline • Process • Interventions proposed • Infection – K. Aziz • CLD – N. Singhal • Interventions implemented • Infection – K. Aziz • CLD – N. Singhal • Future directions – K. Aziz

  3. Review Process • Cochrane reviews • Systematic reviews • Informal reviews

  4. CLD Group Interventions • Process • Experts selected topics • Training provided for literature review • Each centre given ONE topic to review

  5. Review Process • Cochrane reviews • Systematic reviews • Informal reviews

  6. Process cont’d • Meeting of all centre/experts to discuss areas for improvement • Generated list of interventions

  7. Interventions Proposed • Antenatal • Treat urea plasma with erythromycin • Antenatal steroids

  8. Interventions Proposed • Resuscitation • Early within one hour prophylactic surfactant <28 weeks or <1250 g. • Diminish hand ventilation • Decrease 100% oxygen exposure

  9. Interventions Proposed • CPAP • Early CPAP for babies in supplemental oxygen • Long term CPAP

  10. Interventions Proposed • Ventilation • Early use of HFV

  11. Interventions Proposed • Normocarbia • Avoid hypocarbia • PaC02 40-55 mm of Hg

  12. Interventions Proposed • Saturation targets • Saturation targets • > 88 to < 94 ? 93

  13. Interventions Proposed • Nutrition/Fluids • Calories • Decrease fluid use • High dose Vitamin A

  14. Interventions Proposed • Environment • Pain • Massage • Noise • NIDCAP

  15. CLD Interventions Implemented • Antenatal: -Antibiotics -Expectant arrangement of PROM -Antenatal steroids

  16. CLD Interventions Implemented • Resuscitation • Surfactant within 30 minutes • Avoid hand ventilation • Ventilation delivery room • Only Laerdel bags with PEEP • Blended gases

  17. CLD Interventions Implemented • Ventilation • Early HVF – not done • Assist control and volume guarantee • Not done specifically

  18. CLD Interventions Implemented • Normocarbia • PaC02 – 45-55 mm of Hg

  19. CLD Interventions Implemented • Saturation targets • Sat alarm limits 85-95% • Goal 88-92% • Physician orders oxygen as drug

  20. CLD Interventions Implemented • Nutrition/Fluids • ↓ TFI < 32 weeks first few days • TPN within 24 hours • TPN within 4 hours

  21. CLD Interventions Implemented • Environment • Renovations to unit • ↓ sound levels

  22. CLD Interventions Implemented • Others: • Comment card for parents • Avoid re-intubation with CPAP • Perinatal referral policies

  23. > 27 weeks and < 34 weeks Extubate to CPAP if FiO2 <.4 (no time frame) Intubate, BLES Intubate, BLES transfer to NICU (*may be given in NICU after transfer) Extubate to CPAP if FiO2 <.4 at 2 to 4 hours of age and if clinically stable Stabilize then transfer to NICU Early CPAP – EPIC PDSA Cycle # 4 Respiratory Distress? (based on clinical judgment) Yes No Develops respiratory distress? No Routine management*** Yes Routine management*** Routine management*** If > 27 weeks, had HMD and on supplemental FiO2 in first 24 hours of life should be on CPAP *** wean from CPAP as per clinical indications

  24. Thank you

More Related