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Radman M, McGuire J, Sharek P, Baden H, Koth A, DiGeronimo R, Migita D, Barry D, Johnson JB, Rutman L, Vora S. Changes in Inhaled Nitric Oxide Use Across ICUs After Implementation of a Standard Pathway. Pediatr Crit Care Med 2024:00130478-990000000-00346. [PMID: 38786980 DOI: 10.1097/pcc.0000000000003544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator. It is expensive, frequently used, and not without risk. There is limited evidence supporting a standard approach to initiation and weaning. Our objective was to optimize the use of iNO in the cardiac ICU (CICU), PICU, and neonatal ICU (NICU) by establishing a standard approach to iNO utilization. DESIGN A quality improvement study using a prospective cohort design with historical controls. SETTING Four hundred seven-bed free standing quaternary care academic children's hospital. PATIENTS All patients on iNO in the CICU, PICU, and NICU from January 1, 2017 to December 31, 2022. INTERVENTIONS Unit-specific standard approaches to iNO initiation and weaning. MEASUREMENTS AND MAIN RESULTS Sixteen thousand eighty-seven patients were admitted to the CICU, PICU, and NICU with 9343 in the pre-iNO pathway era (January 1, 2017 to June 30, 2020) and 6744 in the postpathway era (July 1, 2020 to December 31, 2022). We found a decrease in the percentage of CICU patients initiated on iNO from 17.8% to 11.8% after implementation of the iNO utilization pathway. We did not observe a change in iNO utilization between the pre- and post-iNO pathway eras in either the PICU or NICU. Based on these data, we estimate 564 total days of iNO (-24%) were saved over 24 months in association with the standard pathway in the CICU, with associated cost savings. CONCLUSIONS Implementation of a standard pathway for iNO use was associated with a statistically discernible reduction in total iNO usage in the CICU, but no change in iNO use in the NICU and PICU. These differential results likely occurred because of multiple contextual factors in each care setting.
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Affiliation(s)
- Monique Radman
- Division of Cardiac Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - John McGuire
- Division of Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Paul Sharek
- Center for Quality and Patient Safety, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Harris Baden
- Division of Cardiac Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Andy Koth
- Division of Cardiac Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Robert DiGeronimo
- Division of Neonatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Darren Migita
- Center for Quality and Patient Safety, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Dwight Barry
- Clinical Analytics, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA
| | - James B Johnson
- Clinical Analytics, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA
| | - Lori Rutman
- Center for Quality and Patient Safety, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Surabhi Vora
- Center for Quality and Patient Safety, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
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