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Specialist neonatal respiratory care for babies born preterm

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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. It reduces the risk of bronchopulmonary dysplasia (BPD) and pneumothorax (collapsed lung), and the number of days on invasive ventilation.

Quality measures

Structure

a) Evidence of local arrangements and written clinical protocols to ensure that preterm babies having invasive ventilation are given VTV in combination with synchronised ventilation.

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

b) Evidence of local arrangements to ensure availability of flow sensors for VTV on neonatal units.

Data source: Local data collection, for example, records of purchase orders and audits of flow sensors for VTV on neonatal units.

Process

Proportion of preterm babies 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 having invasive ventilation.

Data source: Local data collection, for example, audits 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) Proportion of babies with BPD at 36 weeks' postmenstrual age.

Numerator – the number in the denominator with BPD.

Denominator – the number of babies at 36 weeks' postmenstrual age.

Data source: Local data collection, for example, audits of patient records. The National Neonatal Audit Programme (NNAP) measures the number of babies with BPD.

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. They ensure that the flow sensors needed for VTV are available. 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 (such as clinical commissioning groups and NHS England) ensure that the services they commission provide VTV with synchronised ventilation to preterm babies having invasive ventilation. The services they commission ensure that the flow sensors needed for VTV are available.

Preterm babies who need help with breathing using a ventilation machine with a tube that passes into the windpipe are given a type of ventilation that lets healthcare professionals control and maintain the amount of air the baby receives. This may reduce the risk of other problems and the number of days they need to spend in hospital.

Source guidance

Specialist neonatal respiratory care in babies born preterm (2019) NICE guideline NG124, recommendation 1.2.7

Definitions of terms used in this quality statement

Invasive ventilation

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