A Quality Initiative for Optimal Therapeutic Hypothermia during Transport for Neonates with Neonatal Encephalopathy.
A Quality Initiative for Optimal Therapeutic Hypothermia during Transport for Neonates with Neonatal Encephalopathy.
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DOI：
10.1097/pq9.0000000000000056
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发表时间：
2018-03
影响因子：
1.1
通讯作者：
Delaney CA
中科院分区：
文献类型：
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作者：
Bourque SL;Meier SA;Palmer C;Melara DL;Grover TR;Delaney CA
低温治疗 (TH) 的神经保护是新生儿脑病 (NE) 的标准治疗方法，可减少死亡和神经发育障碍。与延迟开始相比，出生后不久开始的 TH 可以产生更好的神经保护作用。使用质量改进方法来改善转运至 IV 级新生儿重症监护病房期间的温度控制。我们纳入了 2010 年至 2016 年间因 NE 被转运到单一机构接受 TH 的新生儿。质量改进干预措施是原来的 2 倍。对运输车身冷却方案的审查显示，温度目标不理想，为 34–35°C；该方案修改为 33–34°C。第二项干预措施是实施主动冷却方案。使用连续变量的 2 样本 t 检验和分类变量的 Fisher 精确检验来比较临床特征；使用统计过程控制图来监测入场温度。我们获得了 2010 年至 2014 年入院的 78 名新生儿的基线数据。这些数据与 2015 年至 2016 年期间入院的 26 名患者的干预后数据进行了比较。两组之间的转运距离、NE 严重程度和癫痫发作相似。主动冷却的使用率从实施前的 8% 增加到实施后的 31% (P < 0.01)。实施2项干预措施后，在33-34℃目标体温范围内入院的婴儿数量有所增加，分别为58%和22%（P < 0.01），新生儿重症监护病房平均入院温度从34.4±0.8℃改善至33.8±0.8℃（P < 0.01）。在 TH 运输过程中增加主动冷却的使用可以提高在目标温度范围内入院的新生儿的百分比。然而，42% 的新生儿仍处于目标温度范围之外，这表明需要其他工具来提高入院温度。
Neuroprotection with therapeutic hypothermia (TH) is standard of care for neonatal encephalopathy (NE) and decreases death and neurodevelopmental disability. TH initiated shortly after birth insult results in greater neuroprotection compared with delayed initiation. Quality improvement methodology was used to improve temperature control during transport to a level IV neonatal intensive care unit. We included neonates with NE transported to a single institution for TH from 2010 to 2016. The quality improvement interventions were 2-fold. Review of the Transport Body Cooling Protocol revealed a suboptimal temperature goal of 34–35°C; this protocol was revised to 33–34°C. The second intervention was the implementation of an active cooling protocol. Clinical characteristics were compared using 2-sample t tests for continuous variables and Fisher’s exact tests for categorical variables; statistical process control chart was used to monitor admission temperatures. We obtained baseline data for 78 neonates admitted from 2010 to 2014. These data were compared with postintervention data for 26 patients admitted between 2015 and 2016. Distance transported, NE severity, and seizures were similar between the 2 groups. The use of active cooling increased from 8% preimplementation to 31% postimplementation (P < 0.01). After implementation of the 2 interventions, more infants were admitted within the goal temperature of 33–34°C, 58% versus 22% (P < 0.01), and the average neonatal intensive care unit admission temperature improved from 34.4 ± 0.8°C to 33.8 ± 0.8°C (P < 0.01). Increased utilization of active cooling during transport for TH improves the percentage of neonates admitted within the target temperature range. However, 42% of neonates remained outside the target temperature range, supporting the need for additional tools to improve admission temperatures.