Quality Improvement in Respiratory Care: Decreasing Bronchopulmonary Dysplasia - 05/08/11

Doi : 10.1016/j.clp.2010.01.015

Robert H. Pfister, MD ^a,^b, Jay P. Goldsmith, MD ^c,^d,^⁎
^a Department of Pediatrics, The University of Vermont, Burlington, VT, USA
^b Fletcher Allen Health Care, Smith 556, 111 Colchester Avenue, Burlington, VT 05401, USA
^c Department of Pediatrics, Tulane University Medical School, 1430 Tulane Avenue, New Orleans, LA 70112-2699, USA
^d 1625 Joseph Street, New Orleans, LA 70115, USA

Corresponding author. 1625 Joseph Street, New Orleans, LA 70115.

Résumé

Chronic lung disease (CLD) is one of the most common long-term complications in very preterm infants. Bronchopulmonary dysplasia (BPD) is the most common cause of CLD in infancy. Modern neonatal respiratory care has witnessed the emergence of a new BPD that exhibits decreased fibrosis and emphysema, but also decreased alveolar septation, and microvascular development. CLD encompasses the classic and the new BPD, and recognizes that lung injury can occur in term infants who need aggressive ventilatory support and who develop lung injury as a result, and that CLD is a multisystem disease. Controversy exists on whether quality improvement (QI) methods that implement multiple interventions will be effective in limiting pathology with multiple causes. Caution in generalization of QI findings is encouraged. QI methods toward improvement in CLD or any other outcome should be considered as a tool for implementing evidence and studying the effects of change in complex adaptive systems.

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Keywords : Chronic lung disease, Quality improvement, Respiratory care, Bronchopulmonary dysplasia