{Reference Type}: Journal Article
{Title}: Sustainable improvement in upstream and downstream outcomes for intubated patients three years after an airway-based educational intervention in a low-resource pediatric intensive care unit.
{Author}: Yager PH;Samost-Williams A;Bonilla JA;Guzman L;Hasbun SCA;Rodríguez AEA;Cárdena A;Núñez AML;Jayawardena ADL;Zablah EJ;Callans KM;Hartnick CJ;
{Journal}: Int J Pediatr Otorhinolaryngol
{Volume}: 182
{Issue}: 0
{Year}: 2024 Jul 8
{Factor}: 1.626
{DOI}: 10.1016/j.ijporl.2024.112011
{Abstract}: <B>OBJECTIVE: </B>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.<BR><B>METHODS: </B>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).<BR><B>METHODS: </B>PICU of the largest public children's hospital in El Salvador.<BR><B>METHODS: </B>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)).<BR><B>METHODS: </B>A low-cost, education-based intervention to close knowledge gaps, improve communication among PICU doctors, nurses, and respiratory therapists, and optimize patient outcomes.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.