OBJECTIVE Our institutional data revealed high pneumothorax rates in term neonates resuscitated in the delivery room (DR). Other studies have reported that high rates of continuous positive airway pressure (CPAP) in the DR are associated with increased pneumothorax rates. We sought to test the hypothesis that quality improvement efforts to reduce the use of CPAP in the DR would be associated with a reduced incidence of pneumothorax. METHODS We performed a series of interventions to make minor revisions to our DR respiratory care algorithm focusing on optimizing CPAP use by providing education to the DR team to the revisions. For neonates born at 36 weeks of gestation or beyond, we evaluated the use of CPAP in the DR and the number of births between pneumothorax events before and after the algorithm was implemented. We used statistical process control charts to assess improvement. RESULTS CPAP utilization in the DR for infants 36 weeks or older decreased from 3.4% to 1.0%. Frequency of pneumothorax decreased, with births between pneumothorax events increasing from 293 to 530. We found no increase in the number of neonates requiring a higher level of care with respiratory distress. CONCLUSION We found that a reduction in the use of CPAP in DR was associated with a decrease in the rate of pneumothorax without an increase in neonates requiring additional care with respiratory distress.

中文翻译：

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一项降低胎龄 36 周或以上出生新生儿气胸率的改进项目。


目的 我们的机构数据显示，在产房 （DR） 复苏的足月新生儿气胸发生率较高。其他研究报告称，DR 中持续气道正压通气 （CPAP） 的高发生率与气胸发生率增加相关。我们试图检验以下假设：减少 DR 中 CPAP 使用的质量改进工作与降低气胸发生率相关。方法 我们进行了一系列干预措施，对我们的 DR 呼吸护理算法进行了细微的修改，重点是通过向 DR 团队提供修订教育来优化 CPAP 的使用。对于妊娠 36 周或更晚出生的新生儿，我们评估了 CPAP 在 DR 中的使用以及实施该算法前后气胸事件之间的出生人数。我们使用统计过程控制图来评估改进情况。结果 DR 中 36 周或以上婴儿的 CPAP 利用率从 3.4% 下降到 1.0%。气胸频率降低，气胸事件之间的出生人数从 293 人增加到 530 人。我们发现需要更高级别护理的呼吸窘迫新生儿数量没有增加。结论 我们发现 DR 中 CPAP 使用的减少与气胸发生率的降低相关，而需要额外护理的呼吸窘迫新生儿没有增加。