Chronic Lung Disease Interventions

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Chronic Lung DiseaseInterventions
N. SinghalUniversity of Calgary November 2006
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Outline

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

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Review Process

• Cochrane reviews
• Systematic reviews
• Informal reviews

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CLD Group Interventions

• Process
• Experts selected topics
• Training provided for literature review
• Each centre given ONE topic to review

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Review Process

• Cochrane reviews
• Systematic reviews
• Informal reviews

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Process contd

• Meeting of all centre/experts to discuss areas
  for improvement
• Generated list of interventions

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Interventions Proposed

• Antenatal
• Treat urea plasma with erythromycin
• Antenatal steroids

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Interventions Proposed

• Resuscitation
• Early within one hour prophylactic surfactant lt28
  weeks or lt1250 g.
• Diminish hand ventilation
• Decrease 100 oxygen exposure

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Interventions Proposed

• CPAP
• Early CPAP for babies in supplemental oxygen
• Long term CPAP

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Interventions Proposed

• Ventilation
• Early use of HFV

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Interventions Proposed

• Normocarbia
• Avoid hypocarbia
• PaC02 40-55 mm of Hg

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Interventions Proposed

• Saturation targets
• Saturation targets
• gt 88 to lt 94 ? 93

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Interventions Proposed

• Nutrition/Fluids
• Calories
• Decrease fluid use
• High dose Vitamin A

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Interventions Proposed

• Environment
• Pain
• Massage
• Noise
• NIDCAP

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CLD Interventions Implemented

• Antenatal -Antibiotics
• -Expectant arrangement of PROM
• -Antenatal steroids

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CLD Interventions Implemented

• Resuscitation
• Surfactant within 30 minutes
• Avoid hand ventilation
• Ventilation delivery room
• Only Laerdel bags with PEEP
• Blended gases

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CLD Interventions Implemented

• Ventilation
• Early HVF not done
• Assist control and volume guarantee
• Not done specifically

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CLD Interventions Implemented

• Normocarbia
• PaC02 45-55 mm of Hg

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CLD Interventions Implemented

• Saturation targets
• Sat alarm limits 85-95
• Goal 88-92
• Physician orders oxygen as drug

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CLD Interventions Implemented

• Nutrition/Fluids
• ? TFI lt 32 weeks first few days
• TPN within 24 hours
• TPN within 4 hours

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CLD Interventions Implemented

• Environment
• Renovations to unit
• ? sound levels

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CLD Interventions Implemented

• Others
• Comment card for parents
• Avoid re-intubation with CPAP
• Perinatal referral policies

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Early CPAP EPIC PDSA Cycle 4
Respiratory Distress? (based on clinical judgment)
Yes
No
Develops respiratory distress?
Routine management
No
Yes
Routine management
Routine management
If gt 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
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• Thank you