In Situ Simulation and Clinical Outcomes in Infants Born Preterm.
In Situ Simulation and Clinical Outcomes in Infants Born Preterm.
复制标题
早产婴儿的原位模拟和临床结果。
DOI：
10.1016/j.jpeds.2023.113715
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Lee,HenryC
中科院分区：
文献类型：
--
作者：
Chitkara,Ritu;Bennett,Mihoko;Bohnert,Janine;Yamada,Nicole;Fuerch,Janene;Halamek,LouisP;Quinn,Jenny;Padua,Kimber;Gould,Jeffrey;Profit,Jochen;Xu,Xiao;Lee,HenryC
目的评价多医院协作质量改进项目实施新生儿复苏现场模拟培训对早产儿临床结局的影响。研究设计12个新生儿重症监护病房分为4个队列，每个队列完成了15个月的程序，在一个阶梯楔形方式。来自加州围产期质量护理协作的数据被用来评估临床结果。纳入妊娠22 - 31周的极低出生体重婴儿。主要结局是无慢性肺部疾病（CLD）的生存率;次要结局包括产房插管、产房持续气道正压通气、新生儿重症监护室入院时体温过低（<36°C）、严重脑室内出血和出院前死亡率。采用混合效应多变量回归模型评估干预效果。ResultsBetween 2017年3月至2020年12月，共有2626名符合条件的极低出生体重儿发生在12个协作参与站点。2017年3月至8月，参与研究中心无CLD的生存率为74.1%，2020年7月至12月为76.0%（风险比1.03; [0.94-1.12]）;研究期间，参与和非参与研究中心均未发生显著改善。原位模拟对所有次要outcomes的影响是stable.ConclusionsImplementation的多医院合作提供原位培训新生儿复苏并没有导致显着改善生存无CLD。正在进行的实地模拟可能对单位做法和无法计量的成果产生影响。
ObjectiveTo evaluate impact of a multihospital collaborative quality improvement project implementing in situ simulation training for neonatal resuscitation on clinical outcomes for infants born preterm.Study designTwelve neonatal intensive care units were divided into 4 cohorts; each completed a 15-month long program in a stepped wedge manner. Data from California Perinatal Quality Care Collaborative were used to evaluate clinical outcomes. Infants with very low birth weight between 22 through 31 weeks gestation were included. Primary outcome was survival without chronic lung disease (CLD); secondary outcomes included intubation in the delivery room, delivery room continuous positive airway pressure, hypothermia (<36°C) upon neonatal intensive care unit admission, severe intraventricular hemorrhage, and mortality before hospital discharge. A mixed effects multivariable regression model was used to assess the intervention effect.ResultsBetween March 2017 and December 2020, a total of 2626 eligible very low birth weight births occurred at 12 collaborative participating sites. Rate of survival without CLD at participating sites was 74.1% in March to August 2017 and 76.0% in July to December 2020 (risk ratio 1.03; [0.94-1.12]); no significant improvement occurred during the study period for both participating and nonparticipating sites. The effect of in situ simulation on all secondary outcomes was stable.ConclusionsImplementation of a multihospital collaborative providing in situ training for neonatal resuscitation did not result in significant improvement in survival without CLD. Ongoing in situ simulations may have an impact on unit practice and unmeasured outcomes.