The Impact of Standardized Respiratory Care Practices on Delivery Room Intubation Frequency and NICU Ventilator Days in VLBW Infants: A Quality Improvement Initiative

Abstract

Objective

Chronic lung disease (CLD) is a common morbidity affecting very low birth weight (VLBW) infants, and exposure to mechanical ventilation in this population is a well-known risk factor. Our 2018 Vermont Oxford Network outcome report demonstrated an increase in the incidence of CLD from 2017 (15%) to 2018 (30.9%).

Study Design

In response, we convened a multidisciplinary team to review our practices. Starting with baseline data on our delivery room (DR) and initial ventilation practices, we developed a key driver diagram to guide change ideas. We implemented sequential interventions using Plan-Do-Study-Act (PDSA) cycles.

Results

From January 2017 through January 2022, 390 infants with birthweights < 1,500 g were admitted to our level IV NICU. Special cause variation was observed in our two-outcome metrics: percent of inborn VLBW infants intubated in the DR, lowering the center line from 44 to 18% and lowering the center line from 19 to 12 total ventilation days per 100 patient days in this same population.

Conclusion

Implementing standardized respiratory care practices resulted in significantly decreasing DR intubation rates and total ventilation days in this vulnerable population.

Key Points

• Employing protective lung strategies in VLBW infants is effective in limiting lung injury and preventing the development of chronic lung disease.

• Implementation of a resuscitation bundle can improve standard processes in the delivery room.

• Prophylactic surfactant replacement continues to be practiced in neonatal units.

Keywords

very low birth weight infant - delivery room intubation - ventilation days - surfactant - pneumothorax

Contributors' Statement

B.F., A.G., L.T., S.M., and P.T. conceptualized and designed the study. P.T., B.F., J.R., L.C., J.H., and J.T. collected data. P.T. performed data analysis and original draft preparation. A.G. and K.J. reviewed, edited, and finalized the manuscript.

Publikationsverlauf

Eingereicht: 18. Dezember 2024

Angenommen: 15. August 2025

Artikel online veröffentlicht:
27. Oktober 2025

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