Minimizing the Duration of Invasive Mechanical Ventilation to Prevent Bronchopulmonary Dysplasia: A Quality Improvement Approach

Abstract

Purpose: Bronchopulmonary dysplasia (BPD) is a chronic lung disease and a major cause of morbidity in preterm infants, especially in those requiring prolonged invasive mechanical ventilation. This quality improvement (QI) initiative aimed to reduce the duration of invasive ventilation, thereby lowering the incidence of BPD in very-lowbirth- weight infants. Methods: A multidisciplinary QI initiative was conducted at the neonatal intensive care unit of Seoul National University Bundang Hospital from February 2022 to June 2024 and compared with historical controls from January 2019 to December 2021. Infants born at <32 weeks of gestation or with a birth weight of <1,500 g were included. Interventions involved standardized protocols addressing the following: minimizing unnecessary intubation in the delivery room; increasing the use of noninvasive surfactant administration; and conducting daily assessments of extubation readiness. The invasive ventilation duration, intubation in the delivery room, surfactant administration techniques, and incidence of BPD were assessed. Results: A total of 358 infants (186 pre-QI and 172 post-QI) were analyzed. The rate of delivery room intubation decreased from 29.7% to 13.8% (P<0.001), and the use of noninvasive surfactant methods increased from 40.6% to 69.1% (P<0.001). The average ventilation duration decreased (17.1±31.8 days vs. 7.2±15.0 days, P<0.001). The incidence of BPD decreased from 57.5% to 45.9% (P=0.045). According to subgroup analysis of infants born at <29 weeks gestation, ventilation duration was significantly reduced (33.8±34.1 days vs. 20.2±20.7 days, P=0.01), but BPD incidence was not significantly different (85.5% vs. 92.7%, P=0.27). In the multivariate logistic regression analysis, only the duration of invasive ventilation was significantly associated with BPD (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.021 to 1.167; P=0.01), but not birth weight (OR, 0.997; 95% CI, 0.995 to 0.999; P=0.001). Conclusion: A structured multidisciplinary intervention effectively reduced the duration of invasive ventilation and BPD. Continued emphasis on comprehensive care bundles may further benefit premature infants.