Quality Improvement Initiative to Improve Initiation and Acceptability of Noninvasive Ventilation in Critically Ill Children

Objectives To evaluate if the use of a quality improvement (QI) initiative improves initiation and acceptability of noninvasive ventilation (NIV) in critically ill children with respiratory distress. Methods The study was carried out in 3 phases over a period of 6 mo in the pediatric intensive care unit of a tertiary care hospital in children aged 2 mo to 14 y of age. In phase 1, data were collected for 1 mo and reasons for NIV failure were identified. In phase 2, process changes like adherence to checklist, monitoring, and one-day orientation program were instituted. The plan-do-study-act (PDSA) cycle was carried out in each phase. In phase 3, which was for 2 mo, the acceptance of NIV was measured and results were compared with phase 1. Results A total of 37 patients were included, 12 in phase 1 and 25 in phase 3. NIV failure was recorded in 5 (42%) and 2 (8%) patients in phase 1 and phase 3 ( p = 0.025), respectively. The cause of NIV failure was intolerance to the interface in both phases. Sedation was used in 18 (72%) patients in phase 3, as compared to 2 patients in phase 1. Conclusions The use of a quality improvement initiative in the form of a protocol, checklist, and training of the treating team resulted in improved tolerance to NIV, and thereby, its success. Use of sedation may help improve tolerance to the interface and contribute to its success.