Jet Ventilation Algorithm Decreases Variations in Practice

Abstract

Background: Variations in practice are common in most institutions based on training and previous experience. Our team sought to minimize those variations to improve patient outcomes and provide best practice for the care of our infants. Prior to the development and implementation of a jet algorithm, patients were initiated on our conventional ventilation protocol and only converted to the jet as a rescue modality, most commonly in our smallest patients within the first few days of life. Furthermore, once the patient was placed on jet ventilation, startup settings varied widely between clinicians and the patients’ clinical status. Variations included starting with or without sigh rates, peak inspiratory pressure range of the sigh rate, peak inspiratory pressure range for jet ventilation, and jet rate. Our goal was to develop a jet algorithm for the highest-risk patients and to decrease variability between providers.

Methods: Multidisciplinary group was formed to develop a ventilation algorithm utilizing jet ventilation for patients with birth weight of 750 g or less of any gestational age that required intubation at birth or within the first 72 h of life. A literature search was performed to evaluate for potential algorithms, and it was noted that a similar institution had publicly provided reference to their developed algorithm. We also consulted with that institution to assure we interpreted their algorithm correctly. Our team created an algorithm similar in nature but, focused on our own institution’s findings of that many infants less than 750 g failed conventional ventilation. In May 2019, our first patient was placed on jet ventilation utilizing the algorithm. After PDSA cycles, slight variations have been made to the algorithm but nothing affecting the initial setup and implementation. Our primary process measure was compliance with the algorithm. Our primary outcome measure was the number of infants on the algorithm. Our balancing measure was the decrease in BPD.

Results: From May 2019 to May 2021, 53 infants met criteria for inclusion into the jet algorithm. 49/53 (93%) of patients were appropriately placed on the Jet algorithm. Four patients were not placed on the Jet algorithm during this time; 2 due to extremely low ventilation and oxygenation needs immediately after birth and 2 due to sigh breaths.

Conclusions: Based on all clinicians initiating and adjusting based on algorithm there has been a decrease in the variations of and patient are prophylactically placed on jet ventilation.