title: Systematic use of the RAM nasal cannula in the Yale-New Haven Children's Hospital Neonatal Intensive Care Unit: a quality improvement project.
abstract: OBJECTIVE
  To evaluate the clinical efficacy of the RAM nasal cannula (NC) with different modes of non-invasive ventilation (NIV) in the neonatal intensive care unit (NICU).
  
  
  METHODS
  A single center prospective, observational study of infants placed on RAM NC. A small trial (Study 1) was completed in 16 infants on NIV via the RAM NC over a 48-h period to create Summary Statement recommendations. Next, over a 10-month period (Study 2), data were prospectively collected for the outcome of all infants receiving respiratory support with the RAM NC. Outcomes were compared between different modes of NIV and whether the recommendations were followed.
  
  
  RESULTS
  The Study 2 population consisted of 88 infants of whom 67 infants received nasal continuous positive airway pressure ventilation (NCPAP) and 21 received nasal intermittent positive pressure ventilation (NIPPV) via the RAM NC. The NIPPV group tended to be younger, smaller and stayed on the RAM NC longer. The overall success rate in weaning off the RAM NC, if our guidelines were followed, was 63%.
  
  
  CONCLUSIONS
  RAM NC use with NIV was well tolerated in the neonatal population with the use of our guidelines. We speculate that use of our guidelines will lead to a more systematic use of the RAM NC in the NICU.
authors.affiliation: Department of Pediatrics, Section of Neonatal-Perinatal Medicine, Yale University School of Medicine , New Haven, CT , USA .
authors.forename: Nneka I
authors.initials: NI
authors.lastname: Nzegwu
authors.forename: Tim
authors.initials: T
authors.lastname: Mack
authors.forename: Roseann
authors.initials: R
authors.lastname: DellaVentura
authors.forename: Louise
authors.initials: L
authors.lastname: Dunphy
authors.forename: Nancy
authors.initials: N
authors.lastname: Koval
authors.forename: Orly
authors.initials: O
authors.lastname: Levit
authors.forename: Vineet
authors.initials: V
authors.lastname: Bhandari
mesh_terms: D057785:Catheters / Q000009:adverse effects / Q000592:standards; D003237:Connecticut / Q000453:epidemiology; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000592:standards* / Q000706:statistics & numerical data; D007385:Intermittent Positive-Pressure Ventilation / Q000009:adverse effects / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000706:statistics & numerical data; D009296:Nasal Cavity; D063087:Noninvasive Ventilation / Q000009:adverse effects / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D011247:Pregnancy; D058996:Quality Improvement; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology / Q000628:therapy*
keywords: Nasal continuous positive airway pressure; nasal intermittent positive pressure ventilation; non-invasive ventilation