Amir Elmekkawi1, Kiran More2, Jennifer Shea1, Christina Sperling3, Zelia Da Silva1, Michael Finelli1, Asaph Rolnitsky4, Robert P Jankov5. 1. Division of Neonatology and. 2. Department of Neonatology, Christchurch Women's Hospital, Christchurch, New Zealand; and. 3. Department of Critical Care, The Hospital for Sick Children, Toronto, Canada. 4. Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Canada. 5. Division of Neonatology and robert.jankov@sickkids.ca.
Abstract
OBJECTIVES: Inhaled nitric oxide (iNO) remains the "gold standard" therapy for hypoxemic respiratory failure in newborns. Despite good quality evidence to guide iNO use in this population, we observed considerable practice variation, particularly in timing and rate of weaning. To promote evidence-based practice, we launched an iNO stewardship program in April 2013. Our objective was to determine whether iNO stewardship led to changes in iNO utilization and weaning. METHODS: We conducted a quality improvement project in an outborn quaternary NICU, targeting improved iNO guideline compliance. We compared patterns of iNO utilization between 2 cohorts: prestewardship (April 2011-March 2013; retrospective data collection) and poststewardship (April 2013-March 2015; prospective data collection). RESULTS: Eighty-seven neonates received 88 courses of iNO in the 2 years prestewardship, and 64 neonates received 64 courses of iNO in the 2 years poststewardship. There were no significant differences (P > .05) in patient demographics, in the proportion of patients receiving iNO "off-label," in proportion initiated at the referring hospital, or in outcomes (death or extracorporeal membrane oxygenation). There were significant (P < .05) reductions in median total hours on iNO per patient (47 vs 20; P < .001), in iNO hours per patient from maximum dose to initial wean (28 vs 9; P < .01), and in hours from initial wean to discontinuation (14 vs 8; P < .05). CONCLUSIONS: The introduction of iNO stewardship was associated with improved adherence to evidence-based guidelines and an overall reduction in total and per-patient iNO use.
OBJECTIVES: Inhaled nitric oxide (iNO) remains the "gold standard" therapy for hypoxemic respiratory failure in newborns. Despite good quality evidence to guide iNO use in this population, we observed considerable practice variation, particularly in timing and rate of weaning. To promote evidence-based practice, we launched an iNO stewardship program in April 2013. Our objective was to determine whether iNO stewardship led to changes in iNO utilization and weaning. METHODS: We conducted a quality improvement project in an outborn quaternary NICU, targeting improved iNO guideline compliance. We compared patterns of iNO utilization between 2 cohorts: prestewardship (April 2011-March 2013; retrospective data collection) and poststewardship (April 2013-March 2015; prospective data collection). RESULTS: Eighty-seven neonates received 88 courses of iNO in the 2 years prestewardship, and 64 neonates received 64 courses of iNO in the 2 years poststewardship. There were no significant differences (P > .05) in patient demographics, in the proportion of patients receiving iNO "off-label," in proportion initiated at the referring hospital, or in outcomes (death or extracorporeal membrane oxygenation). There were significant (P < .05) reductions in median total hours on iNO per patient (47 vs 20; P < .001), in iNO hours per patient from maximum dose to initial wean (28 vs 9; P < .01), and in hours from initial wean to discontinuation (14 vs 8; P < .05). CONCLUSIONS: The introduction of iNO stewardship was associated with improved adherence to evidence-based guidelines and an overall reduction in total and per-patient iNO use.
Authors: Walid A Hussain; Deborah S Bondi; Pooja Shah; Sherwin E Morgan; Sudhir Sriram; Michael D Schreiber Journal: J Pediatr Pharmacol Ther Date: 2022-03-21
Authors: Amish Jain; Regan E Giesinger; Shyamala Dakshinamurti; Yasser ElSayed; Robert P Jankov; Dany E Weisz; Satyan Lakshminrusimha; Souvik Mitra; Mjaye L Mazwi; Joseph Ting; Michael Narvey; Patrick J McNamara Journal: J Perinatol Date: 2022-01-11 Impact factor: 3.225
Authors: Laura Thomas; Michelle Baczynski; Poorva Deshpande; Ashraf Kharrat; Sébastien Joye; Faith Zhu; Daniel Ibarra-Rios; Prakesh S Shah; Luc Mertens; Robert P Jankov; Xiang Y Ye; Elaine Neary; Joseph Ting; Michael Castaldo; Philip Levy; Aisling Smith; Afif F El-Khuffash; Regan E Giesinger; Patrick J McNamara; Dany E Weisz; Amish Jain Journal: BMJ Open Date: 2021-03-31 Impact factor: 2.692