O1068 Oct.4: 4:49pm - Monitoring respiratory support with a high frequency data logger during neonatal transport and its impact on clinical practice

Background
Respiratory support during emergency and elective neonatal transfers have been the gold standard of emergency neonatal care. Volume targeted ventilation (VTV), also known as volume guarantee (VG) has been increasingly used on neonatal intensive care units worldwide. Systematic reviews comparing VG with pressure limited ventilation have shown significant short and long term benefits. Early initiation of this advanced ventilator mode during the stabilization period and throughout the neonatal transfer is arguable in most clinical situations. However there are limited studies and papers on VG mode during neonatal transport.
Objective
To collect all ventilator parameters with a high sampling rate during neonatal transport, analyse the data and implement findings into our everyday clinical practice.
Methods
Clinical and ventilator data have been collected from all infants transferred by the Neonatal Emergency and Transport Service of the Peter Cerny Foundation (NETS-PCA, Budapest, Hungary) since 20/03/2017 who received invasive or noninvasive respiratory support during inter-hospital transport.
All the ventilator data have been downloaded with a data logger developed by the ventilator manufacturer. The software downloads all ventilator parameters and settings including peak inspiratory pressure, positive end-expiratory pressure, inspiratory and expiratory tidal volume, inspiratory and expiratory time, and fraction of inspired oxygen (FiO2) at a 0.5 Hz sampling rate.
Data have been analyzed using the Python computer language and its data analysis packages.
We have implemented a quality improvement project to develop clinical practice and to improve patient safety using prospective data collection, regular case reviews and educational meetings. Inclusion criteria for a formal case review were as follows: (1) severe respiratory acidosis on arrival with pH <7.2 and pCO2 >60 mmHg; (2) severe respiratory alkalosis with pH >7.5 and pCO2 6 ml/kg); (4) FiO2 = 1.0 during significant part of transfer; (5) The clinical care team raising concerns about potential points of improvement.
Results
Between 20/03/2017 and 04/09/2019, 342 hours of mechanical ventilation was recorded, from 272 patients, obtaining over 600,000 data points. 25 formal case reviews have been performed with in-depth ventilation and clinical data analysis. Several practical and clinical findings have been discussed with the following results: more conscious use of VG ventilation, optimal use of PMAX settings, more effective ventilation considering the leak compensation, use of optimal ventilation settings in different clinical situations (extreme prematurity, meconium aspiration, hypoxic ischaemic encephalopathy, etc.).
Conclusion
High-frequency computational data collection during stabilization and inter-hospital neonatal transfer is a uniqe technique offering several opportunities. Regular case reviews based on prospective systematic data collection and analysis provide clinicians regular and objective feedback and help the team maintain continuous education and improve service quality and patient safety.