Quality improvement to reduce chronic lung disease rates in very-low birth weight infants: high compliance with a respiratory care bundle in a small NICU

Objectivereduce chronic lung disease by 10% among very-low birth weight infants by implementing a consistent respiratory care bundle.study designprospective quality improvement study of infants below 32 weeks gestation in a small neonatal intensive care unit. a respiratory care bundle to eliminate inter-provider variability and minimize use of mechanical ventilation was implemented. this included: defining delivery room management with use of continuous positive airway pressure/nasal intermittent positive pressure ventilation, uniform intubation/extubation criteria, and standardizing ventilation/post-extubation support.resultsa total of 107 very-low birth weight infants were included in this project. compliance with the respiratory care bundle was >90%. chronic lung disease rates at 36 weeks postmenstrual age fell from 43 to 12% (p = 0.0006), rates of combined chronic lung disease/death decreased from 50 to 20% (p = 0.002, or = 0.25, 95% ci 0.1–0.6), rates of severe intraventricular hemorrhage decreased from 13 to 0% (p = 0.005), and surgical ligation of patent ductus arteriosus decreased from 35 to 3% (p < 0.0001).conclusionhigh compliance with the respiratory care bundle was achieved and a 73% reduction in chronic lung disease rates in very-low birth weight infants occurred.