CPQCC Quality Improvement Toolkit_Improving Initial Lung Function: Early CPAP,Surfactant and Other Means
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CPQCC Quality Improvement Toolkit_Improving Initial Lung Function: Early CPAP,Surfactant and Other Means
Original Date:Revised 3/7/22Cover Letter of ChangesThis revised version of the California Perinatal Quality Care Collaborative (CPQCC) Toolkit Improvi CPQCC Quality Improvement Toolkit_Improving Initial Lung Function: Early CPAP,Surfactant and Other Means ing Initial Lung Function: Surfactant and Other Means has been updated with newer studies and relevant literature on surfactant and continuous positive airway pressure (CPAP). The rationale for both of these interventions is that they both have the potential to reduce chronic lung disease, which we CPQCC Quality Improvement Toolkit_Improving Initial Lung Function: Early CPAP,Surfactant and Other Means win refer to as bronchopulmonary dysplasia (BPD) or chronic lung disease interchangeably throughout. We have included the N1H consensus definition ofCPQCC Quality Improvement Toolkit_Improving Initial Lung Function: Early CPAP,Surfactant and Other Means
BPD and the physiologic definition of BPD, as there has been information that increasing severity of BPD is associated with increased NDIFor the use oOriginal Date:Revised 3/7/22Cover Letter of ChangesThis revised version of the California Perinatal Quality Care Collaborative (CPQCC) Toolkit Improvi CPQCC Quality Improvement Toolkit_Improving Initial Lung Function: Early CPAP,Surfactant and Other Means mains a very beneficial therapy for the preterm infant with respirator}'- distress and/or immature lungs. It is perhaps surprising and not well appreciated that the following have been noted:•Most studies of the use of surfactant have not reported a significant reduction in BPD, and that such findin CPQCC Quality Improvement Toolkit_Improving Initial Lung Function: Early CPAP,Surfactant and Other Means gs have only recently been suggested in secondary' analyses of the meta analyses for the most immature infants.•Surfactant has not been found to signiCPQCC Quality Improvement Toolkit_Improving Initial Lung Function: Early CPAP,Surfactant and Other Means
ficantly reduce subsequent neurodevelopmental impairment (NDI), but has reduced death and not been associated with increased NDI in such survivors.•ThOriginal Date:Revised 3/7/22Cover Letter of ChangesThis revised version of the California Perinatal Quality Care Collaborative (CPQCC) Toolkit Improvi CPQCC Quality Improvement Toolkit_Improving Initial Lung Function: Early CPAP,Surfactant and Other Means ducts. Artificial products devoid of animal protein offer the theoretical advantage of avoidance of sensitization for the infant or the transmission any disorders carried in such material. In this review we have not compared natural and artificial surfactants.We have added information regarding surf CPQCC Quality Improvement Toolkit_Improving Initial Lung Function: Early CPAP,Surfactant and Other Means actant administration followed by rapid extubation and the use of subsequent CPAP as this approach is being adopted by many centers. There are no signCPQCC Quality Improvement Toolkit_Improving Initial Lung Function: Early CPAP,Surfactant and Other Means
ificant prospective trials comparing prophylactic versus early versus later rescue surfactant, and thus no good rationale for the immediate intubationOriginal Date:Revised 3/7/22Cover Letter of ChangesThis revised version of the California Perinatal Quality Care Collaborative (CPQCC) Toolkit Improvi CPQCC Quality Improvement Toolkit_Improving Initial Lung Function: Early CPAP,Surfactant and Other Means ed with good outcomes. In the very tiniest and fragile of infant’s airway obstruction secondary to surfactant administration may be problematic. We have utilized the most recent meta analyses for the use of surfactant in the premature infant.The other major intervention discussed in this Toolkit is CPQCC Quality Improvement Toolkit_Improving Initial Lung Function: Early CPAP,Surfactant and Other Means the use of early CPAP. While there has been a great deal written about this intervention, there were previously no prospective randomized trials compaCPQCC Quality Improvement Toolkit_Improving Initial Lung Function: Early CPAP,Surfactant and Other Means
ring early CPAP to surfactant or other interventions. This revision includes information from the recently completed and published trials, which incluOriginal Date:Revised 3/7/22Cover Letter of ChangesThis revised version of the California Perinatal Quality Care Collaborative (CPQCC) Toolkit Improvi CPQCC Quality Improvement Toolkit_Improving Initial Lung Function: Early CPAP,Surfactant and Other Means summary', these individual studies showed no difference in the primary outcome of Death or BPD between the CPAP and intubation groups but did show a decrease in other short term respiratory outcomes including the need for intubation, days of mechanical ventilation, mechanical ventilation at 7days, a CPQCC Quality Improvement Toolkit_Improving Initial Lung Function: Early CPAP,Surfactant and Other Means nd steroids for BPD. The1Original Date:Revised 3/7/22COIN (rial showed an increase in the pneumothorax in the CPAP group; however this was not seen inCPQCC Quality Improvement Toolkit_Improving Initial Lung Function: Early CPAP,Surfactant and Other Means
the other 3 studies. The overall meta analysis confirmed that the trend seen in all trials toward a decrease in death or survival with BPD, was indeeOriginal Date:Revised 3/7/22Cover Letter of ChangesThis revised version of the California Perinatal Quality Care Collaborative (CPQCC) Toolkit Improvi CPQCC Quality Improvement Toolkit_Improving Initial Lung Function: Early CPAP,Surfactant and Other Means uce the occurrence of BPD at neonatal discharge and hopefully ND1 at 2 years of age. As further evidence becomes available in the next few years, we will endeavor to keep this toolkit relevant and evidence based.Original Date:Revised 3/7/22Improving Initial Lung Function: Early CPAP, Surfactant and CPQCC Quality Improvement Toolkit_Improving Initial Lung Function: Early CPAP,Surfactant and Other Means Other MeansReducing Chronic Lung DiseaseQuality Improvement ToolkitCalifornia Perinatal Quality Care CollaborativeNeil Finer, MD, David Wirtschdfler,CPQCC Quality Improvement Toolkit_Improving Initial Lung Function: Early CPAP,Surfactant and Other Means
MD, Priya Jegalheesan MD, Courtney Nisbet, RN, MS on behalf ol lhe Perinatal Quality Improvement Panel (PQĨP), California Perinatal Quality Care CollaOriginal Date:Revised 3/7/22Cover Letter of ChangesThis revised version of the California Perinatal Quality Care Collaborative (CPQCC) Toolkit Improvi CPQCC Quality Improvement Toolkit_Improving Initial Lung Function: Early CPAP,Surfactant and Other Means Vlllarin Duenas, MPHCPQCC Program ManagerCele Quaintance, RN, MSPQIP Members:Richard Bell, MDNorth Bay Medical Center, FairfieldOriginal Date:Revised 3/7/22Cover Letter of ChangesThis revised version of the California Perinatal Quality Care Collaborative (CPQCC) Toolkit ImproviGọi ngay
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