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Neonatal-Perinatal Health Care Delivery: Practices and Procedures

Neonatal-Perinatal Health Care Delivery 2: Practices: Monitoring, Devices, Respiratory Care

739 - Interdisciplinary Perspectives on Non-Invasive Respiratory Support Practices and Monitoring in Extremely Preterm Infants: A Canadian Survey

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 739
Publication Number: 739.245

Tugba Alarcon Martinez, McGill University Faculty of Medicine and Health Sciences, Melbourne, Victoria, Australia; Stephanie Mardakis, McGill University Health Centre, Montreal, PQ, Canada; Elissa Remmer, McGill University Health Center, Montreal, PQ, Canada; Marisa Leone, Montréal Children's Hospital, St. Leonard, PQ, Canada; Johanne F. Boyer, Montreal Children's Hospital, Montreal, PQ, Canada; Guilherme Sant'Anna, McGill University Health Center, MONTREAL, PQ, Canada; Marc Beltempo, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada; Wissam Shalish, Division of Neonatology, Montreal Children’s Hospital, McGill University Health Center, Montreal, Quebec, Canada, Montreal, PQ, Canada

Presenting Author(s)

WS

Wissam Shalish, MD, PhD

Neonatologist
Division of Neonatology, Montreal Children’s Hospital, McGill University Health Center, Montreal, Quebec, Canada
Montreal, Quebec, Canada

Background: Non-invasive respiratory support (NRS) is commonly used in extremely preterm infants (gestational age < 28w) and involves interdisciplinary collaboration between different healthcare professionals for its optimal provision.

Objective: To describe the perspectives of neonatologists, neonatal fellows, nurses, and respiratory therapists (RTs) on the provision of NRS and its monitoring.

Design/Methods: A web-based anonymized 19-question survey was sent to healthcare professionals across 23 tertiary care NICUs in Canada via their respective directors. The survey inquired about perspectives on specific NRS devices and settings during the acute phase, monitoring and management of cardiorespiratory events, reasons for NRS failure, and possible solutions. Responses were described overall and per category of provider (physicians, nurses, RTs) using descriptive statistics.

Results: 381 responses from 61 physicians (47 neonatologists, 14 neonatal fellows), 173 nurses, and 147 RTs were analyzed. The NRS mode which providers were most exposed to was continuous positive airway pressure (CPAP, 65%) using maximum pressures of 8 cm H₂O [IQR 8-10], followed by nasal intermittent positive pressure ventilation (NIPPV, 21%) using maximum peak inflation pressures of 20 cm H₂O [IQR 18-24]. Most respondents (66%) preferred alternating between prongs and mask to deliver NRS. While 82% of physicians and 80% of RTs perceived CPAP levels in their unit to be appropriate, 35% of nurses were uncertain or believed that pressures were inappropriately high. Only 56% of respondents perceived NIPPV levels in their unit to be appropriate. Overall provision of NRS was considered challenging by 62%, 45%, and 45% of physicians, nurses, and RTs, respectively (Table 1). For cardiorespiratory events, 20% of respondents stated that nursing documentation was unreliable and only 35% agreed on documenting spontaneously recovering events. Although 57% of respondents perceived their unit to be very tolerant to events, 44% of physicians felt that reintubation could often be prevented compared to 24% of nurses and 26% of RTs (Table 2). As for training, 17% of respondents evaluated their training on NRS provision as neutral or insufficient, and 71% suggested regular hands-on workshops for continuing education (Table 3).

Conclusion(s): There remain important uncertainties and variations across disciplines on how to best approach NRS provision and monitoring in extremely preterm infants. Better scientific evidence on NRS modalities/settings, together with the development of interdisciplinary guidelines and enhanced training, might reduce variability.