Abstract：
OBJECTIVE: To determine whether implementation of an education-based intervention can sustainably improve upstream and downstream outcomes in intubated patients in a pediatric intensive care unit (PICU) in a low-resource country.
METHODS: Quality improvement study comparing airway-related morbidity in two previously studied patient cohorts pre-intervention (Epoch 1) and immediately post-intervention (Epoch 2) with a third cohort thirty-six months post-intervention (Epoch 3).
METHODS: PICU of the largest public children\'s hospital in El Salvador.
METHODS: 147 patients under 18 years requiring intubation and mechanical ventilation (MV) met inclusion criteria in the long-term follow-up period and were consecutively sampled without exclusion (Epoch 3) (compared to 98 previously studied patients in the short-term follow-up period (Epoch 2)).
METHODS: A low-cost, education-based intervention to close knowledge gaps, improve communication among PICU doctors, nurses, and respiratory therapists, and optimize patient outcomes.
RESULTS: The primary outcome measure was change in unplanned extubation (UE) between Epochs 2 and 3. Other outcomes included use of cuffed endotracheal tubes (ETT), rate of elective ETT change and days of MV. The 17 % decrease in UE previously reported for Epoch 2 was sustained in Epoch 3. There was a statistically significant increase in use of cuffed ETT from 35.7 % in Epoch 2-55.1 % in Epoch 3 (p = 0.003, z-score -2.99). There was also a statistically significant mean difference in rate of elective ETT change per 100 MV days from Epoch 2 to Epoch 3 of 1.7 (p = 0.007; 95 % CI 0.15-0.84). There was no change in MV days from Epoch 2 to Epoch 3 (p-value 0.764; 95 % CI -1.48-2.02). Beyond these quantifiable results, many unanticipated practice changes were observed three years after the initial intervention.
CONCLUSIONS: Sustained improvement in upstream and downstream outcomes (UE, cuffed ETT use, elective ETT change) for intubated patients in a low-resource PICU were observed three years after a low-cost, low-touch, education-based intervention.
METHODS: Quality improvement study comparing airway-related morbidity in two previously studied patient cohorts pre-intervention (Epoch 1) and immediately post-intervention (Epoch 2) with a third cohort thirty-six months post-intervention (Epoch 3).
METHODS: PICU of the largest public children\'s hospital in El Salvador.
METHODS: 147 patients under 18 years requiring intubation and mechanical ventilation (MV) met inclusion criteria in the long-term follow-up period and were consecutively sampled without exclusion (Epoch 3) (compared to 98 previously studied patients in the short-term follow-up period (Epoch 2)).
METHODS: A low-cost, education-based intervention to close knowledge gaps, improve communication among PICU doctors, nurses, and respiratory therapists, and optimize patient outcomes.
RESULTS: The primary outcome measure was change in unplanned extubation (UE) between Epochs 2 and 3. Other outcomes included use of cuffed endotracheal tubes (ETT), rate of elective ETT change and days of MV. The 17 % decrease in UE previously reported for Epoch 2 was sustained in Epoch 3. There was a statistically significant increase in use of cuffed ETT from 35.7 % in Epoch 2-55.1 % in Epoch 3 (p = 0.003, z-score -2.99). There was also a statistically significant mean difference in rate of elective ETT change per 100 MV days from Epoch 2 to Epoch 3 of 1.7 (p = 0.007; 95 % CI 0.15-0.84). There was no change in MV days from Epoch 2 to Epoch 3 (p-value 0.764; 95 % CI -1.48-2.02). Beyond these quantifiable results, many unanticipated practice changes were observed three years after the initial intervention.
CONCLUSIONS: Sustained improvement in upstream and downstream outcomes (UE, cuffed ETT use, elective ETT change) for intubated patients in a low-resource PICU were observed three years after a low-cost, low-touch, education-based intervention.
摘要：
目的：确定在资源匮乏的国家，在儿科重症监护病房（PICU）中实施基于教育的干预措施是否可以持续改善患者的上游和下游结局。
方法：质量改进研究比较了干预前（时代1）和干预后立即（时代2）的两个先前研究的患者队列与气道相关的发病率与干预后36个月（时代3）的第三个队列。
方法：萨尔瓦多最大的公立儿童医院的PICU。
方法：147名18岁以下需要插管和机械通气（MV）的患者在长期随访期间符合纳入标准，并连续取样，不排除（时期3）（与98名先前研究的短期随访患者相比（时期2））。
方法：低成本，以教育为基础的干预措施，以缩小知识差距，改善PICU医生之间的沟通，护士,和呼吸治疗师，优化患者预后。
结果：主要结果指标是第2和第3阶段之间的计划外拔管（UE）变化。其他结果包括使用袖口气管导管（ETT），选择性ETT变化率和MV天数。先前报告的用于时代2的UE减少17%在时代3中持续。使用带袖口的ETT从时代2的35.7%增加到时代3的55.1%(p=0.003,z-评分-2.99)。从时代2到时代3，每100MV天的选择性ETT变化率也有统计学上的显着差异，为1.7（p=0.007；95％CI0.15-0.84）。从时代2到时代3的MV天数没有变化(p值0.764;95%CI-1.48-2.02)。除了这些可量化的结果，在初次干预3年后观察到许多意想不到的实践变化.
结论：上游和下游结果持续改善(UE，袖口ETT使用，选择性ETT改变）在低资源PICU中插管的患者在低成本后三年观察到，低接触，以教育为基础的干预。
方法：质量改进研究比较了干预前（时代1）和干预后立即（时代2）的两个先前研究的患者队列与气道相关的发病率与干预后36个月（时代3）的第三个队列。
方法：萨尔瓦多最大的公立儿童医院的PICU。
方法：147名18岁以下需要插管和机械通气（MV）的患者在长期随访期间符合纳入标准，并连续取样，不排除（时期3）（与98名先前研究的短期随访患者相比（时期2））。
方法：低成本，以教育为基础的干预措施，以缩小知识差距，改善PICU医生之间的沟通，护士,和呼吸治疗师，优化患者预后。
结果：主要结果指标是第2和第3阶段之间的计划外拔管（UE）变化。其他结果包括使用袖口气管导管（ETT），选择性ETT变化率和MV天数。先前报告的用于时代2的UE减少17%在时代3中持续。使用带袖口的ETT从时代2的35.7%增加到时代3的55.1%(p=0.003,z-评分-2.99)。从时代2到时代3，每100MV天的选择性ETT变化率也有统计学上的显着差异，为1.7（p=0.007；95％CI0.15-0.84）。从时代2到时代3的MV天数没有变化(p值0.764;95%CI-1.48-2.02)。除了这些可量化的结果，在初次干预3年后观察到许多意想不到的实践变化.
结论：上游和下游结果持续改善(UE，袖口ETT使用，选择性ETT改变）在低资源PICU中插管的患者在低成本后三年观察到，低接触，以教育为基础的干预。
