Current Research
Implementation of a guideline for standardization of peri-extubation practices at McMaster NICU:
A Quality Improvement project
In an effort to enhance respiratory outcomes for preterm infants, our quality improvement project has implemented a peri-extubation guideline, for all infants born before 29 weeks' gestation.
This approach was informed by a systematic review and a recent unit audit that revealed a high re-intubation rate. Our standardized care includes pausing enteral feeds for two hours before and after extubation, maintaining IV access for hydration and emergency medication administration, and providing positive pressure ventilation via the endotracheal tube with a flow-inflating bag throughout the extubation procedure. Specifically, infants older than 72 hours, with an intubated mean airway pressure (MAP) of 13 or less and with a leak rate under 50%, are to receive post-extubation CPAP at levels 2 cmH2O higher than the pre-extubation MAP. The primary objective of this initiative is to reduce the re-intubation rate by 50%, aiming to significantly improve the care and outcomes of these vulnerable neonates.
Building upon the implementation of the QI initiative at McMaster, as well as previous research from our group, in this CIHR funded study - in collaboration with EPIQ and CNN and 22 Canadian centres, as plan to compare clinical outcomes (main outcome: re-insertion of breathing tube) in babies from centres that choose higher pressures following extubation vs. babies from centres that use standard pressures following extubation.
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Current Status: In planning stage, expected duration of study: 3 years (until Sept 2027)
