title: Decreased incidence of pneumothorax in VLBW infants after increased monitoring of tidal volumes.
abstract: OBJECTIVE
  Pneumothorax is common in very low birth weight (VLBW) infants. In our NICU, we noted an above average incidence of pneumothorax compared with similar NICUs based on Vermont Oxford Network benchmarking. The quality improvement project was designed to decrease the incidence of pneumothorax in VLBW infants in a tertiary care NICU.
  
  
  METHODS
  The project was divided into 2 periods. During period 1, all VLBW infants were followed for 6 months for the presence of pneumothorax. A multidisciplinary team met regularly to review cases of pneumothorax and identify potential causes. High tidal volumes (VT) (>6 mL/kg) were noted around the time of occurrence of pneumothorax. Guidelines were developed for improved monitoring and rapid feedback of VT and peak inspiratory pressure between nursing staff and clinicians. During period 2, these guidelines were implemented and VLBW infants were again followed for 6 months. The incidence of pneumothorax was tracked. Run charts were used to monitor changes.
  
  
  RESULTS
  The incidence of pneumothorax in VLBW infants decreased from 10.4% to 2.6% after the intervention (P = .04). By using process control, a reduction in pneumothorax was achieved in period 2.
  
  
  CONCLUSIONS
  Increased vigilance and real-time monitoring of VT and peak inspiratory pressure decreased the incidence of pneumothorax in our population of VLBW infants. These interventions can be considered in other NICUs with an above-average risk adjusted incidence of pneumothorax in VLBW infants. Our data illustrate the benefits of comparative benchmarking and organized quality improvement in advancing patient care outcomes.
authors.affiliation: Department of Pediatrics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Haritha
authors.initials: H
authors.lastname: Vellanki
authors.forename: Michael
authors.initials: M
authors.lastname: Antunes
authors.forename: Robert G
authors.initials: RG
authors.lastname: Locke
authors.forename: Theresa
authors.initials: T
authors.lastname: McGreevy
authors.forename: Amy
authors.initials: A
authors.lastname: Mackley
authors.forename: Jacquline J
authors.initials: JJ
authors.lastname: Eubanks
authors.forename: Mike
authors.initials: M
authors.lastname: Western
authors.forename: John
authors.initials: J
authors.lastname: Emberger
authors.forename: David A
authors.initials: DA
authors.lastname: Paul
mesh_terms: D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008991:Monitoring, Physiologic; D011030:Pneumothorax / Q000453:epidemiology* / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013990:Tidal Volume