409 - Utilization of non-invasive neurally adjusted ventilation assist (NI-NAVA) to improve short term respiratory outcomes in extremely preterm infants: A quality improvement project

Poster Number: 409
Publication Number: 409.2293

Background: Extremely preterm ( < 28 weeks’ gestation) and extremely low birth weight (ELBW, < 1000 grams) infants are at a higher risk of having poor respiratory outcomes such as prolonged mechanical ventilation, extubation failure, prolonged hospitalizations, and chronic lung disease. Non-invasive neurally adjusted ventilation assist (NI-NAVA) is a relatively new mode of ventilation that utilizes electrical activity of the diaphragm to provide respiratory support. There is evidence that its consistent use can decrease extubation failure, which may improve short-term respiratory outcomes.

Objective: The aim of this quality improvement (QI) project is to decrease the rate of extubation failure in extremely preterm infants by 20% within one year.

Design/Methods: This QI initiative was performed at a level IV Intensive Care Nursery at UCSF-Mission Bay. A multi-disciplinary QI team was formed and met frequently during the planning stages. Using Lean process improvement methodology, an A3 and key driver diagram was created to develop targeted interventions to improve respiratory outcomes for extremely preterm infants. Interventions included increasing extubation of mechanically ventilated ELBW infants to NI-NAVA, creation of a NI-NAVA guideline to standardize use, and widespread dissemination of NI-NAVA education. The pre-intervention period was from Jan 2022-Jun 2022 (15 infants) and the post-intervention period was from Jul 2022-Apr 2023 (16 infants). The primary outcomes were the rate of extubation failure and days of mechanical ventilation within first 4 weeks. Rate of extubation to NI-NAVA was the process measure. Data was analyzed on run charts.

Results: Our intervention increased extubation to NI-NAVA from 62% to 92% of all extubation episodes in ELBW infants. Extubation failure decreased from 33% to 22% during the same time period, surpassing our goal of a 20% reduction. Average number of mechanically ventilated days in the first 4 weeks of life was stable at 6 days.

Conclusion(s): Using core QI methodology, we successfully implemented the use of NI-NAVA upon extubation for extremely preterm infants, which was associated with a reduction in extubation failure.