Quality standard

Quality statement 3: Invasive ventilation

Quality statement 3: Invasive ventilation

Quality statement

Preterm babies having invasive ventilation are given volume-targeted ventilation (VTV) in combination with synchronised ventilation.

Rationale

VTV in combination with synchronised ventilation has a lower mortality rate before discharge in preterm babies compared with other invasive ventilation techniques. It also reduces the risk of bronchopulmonary dysplasia (BPD) and pneumothorax (collapsed lung), and the number of days on invasive ventilation.

Quality measures

Structure

Evidence of local arrangements to ensure that preterm babies having invasive ventilation are given VTV in combination with synchronised ventilation.

Data source: Local data collection, for example, clinical protocols.

Process

a) Proportion of preterm babies born under 28 weeks of pregnancy having invasive ventilation who were given VTV in combination with synchronised ventilation.

Numerator – the number in the denominator who were given VTV in combination with synchronised ventilation.

Denominator – the number of preterm babies born under 28 weeks of pregnancy having invasive ventilation.

Data source: Local data collection, for example, local audit of patient records.

b) Proportion of preterm babies born between 28 weeks and 31 weeks plus 6 days of pregnancy having invasive ventilation who were given VTV in combination with synchronised ventilation.

Numerator – the number in the denominator who were given VTV in combination with synchronised ventilation.

Denominator – the number of preterm babies born between 28 weeks and 31 weeks plus 6 days of pregnancy having invasive ventilation.

Data source: Local data collection, for example, local audit of patient records.

c) Proportion of preterm babies born between 32 weeks and 36 weeks plus 6 days of pregnancy having invasive ventilation who were given VTV in combination with synchronised ventilation.

Numerator – the number in the denominator who were given VTV in combination with synchronised ventilation.

Denominator – the number of preterm babies born between 32 weeks and 36 weeks plus 6 days of pregnancy having invasive ventilation.

Data source: Local data collection, for example, local audit of patient records.

Outcome

a) Number of days preterm babies spend on invasive ventilation.

Data source: Local data collection, for example, audits of patient records.

b) Incidence of pneumothorax in preterm babies.

Data source: Local data collection, for example, audits of patient records.

c) Number of preterm babies with BPD.

Data source: The National Neonatal Audit Programme (NNAP) measures the number of eligible babies alive at 36 weeks with sufficient data to attribute BPD outcome.

What the quality statement means for different audiences

Service providers (such as neonatal units, including special care units, local neonatal units and neonatal intensive care units) ensure that systems are in place for preterm babies to be given VTV with synchronised ventilation if they are having invasive ventilation. Most units have flow sensors for triggered ventilation and the same sensor can be used for VTV.

Healthcare professionals (such as specialist neonatal nurses, specialist neonatal consultants and other paediatric specialists working with babies born preterm) ensure that they use VTV with synchronised ventilation for preterm babies who are having invasive ventilation.

Commissioners (NHS England) ensure that the services they commission provide VTV with synchronised ventilation to preterm babies having invasive ventilation.

Preterm babies using a ventilation machine to help them breathe are given a type of ventilation that lets healthcare professionals control and maintain the volume of gas the baby receives per breath. This may reduce the risk of other problems and the number of days they need to spend in hospital.

Definitions of terms used in this quality statement

Bronchopulmonary dysplasia (BPD)

A chronic lung disease that develops in preterm babies. [NICE's guideline on specialist neonatal respiratory care for babies born preterm, supplement 1: glossary and abbreviations]

Invasive ventilation

Administration of respiratory support via an endotracheal tube or tracheostomy, using a mechanical ventilator. [NICE's guideline on specialist neonatal respiratory care for babies born preterm, terms used in this guideline section]