Evidence map›Paper›PMID 30229151›Full record

ArticlePediatric quality & safety

A Quality Improvement Initiative to Standardize Use of Inhaled Nitric Oxide in the PICU.

Todd J Karsies, Laura Evans, Randall Frost, Onsy Ayad, Richard McClead

Open access · diamondAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Pediatric quality & safety. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.6field-weighted citation impact, top 26% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 5 citations in OpenAlex.

  1. A quality improvement project improving the value of iNO utilization in preterm and term infants.Journal of perinatology : official journal of the California Perinatal Association · 2021
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 1 institution in 1 country.

Todd J KarsiesDepartment of Pediatrics, Pediatric Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Respiratory Therapy, Nationwide Children's Hospital, Columbus, Ohio; Department of Quality Improvement Services, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, Office of the Chief Medical Officer, Nationwide Children's Hospital, Columbus, Ohio.
Laura EvansDepartment of Pediatrics, Pediatric Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Respiratory Therapy, Nationwide Children's Hospital, Columbus, Ohio; Department of Quality Improvement Services, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, Office of the Chief Medical Officer, Nationwide Children's Hospital, Columbus, Ohio.
Randall FrostDepartment of Pediatrics, Pediatric Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Respiratory Therapy, Nationwide Children's Hospital, Columbus, Ohio; Department of Quality Improvement Services, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, Office of the Chief Medical Officer, Nationwide Children's Hospital, Columbus, Ohio.
Onsy AyadDepartment of Pediatrics, Pediatric Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Respiratory Therapy, Nationwide Children's Hospital, Columbus, Ohio; Department of Quality Improvement Services, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, Office of the Chief Medical Officer, Nationwide Children's Hospital, Columbus, Ohio.
Richard McCleadDepartment of Pediatrics, Pediatric Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Respiratory Therapy, Nationwide Children's Hospital, Columbus, Ohio; Department of Quality Improvement Services, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, Office of the Chief Medical Officer, Nationwide Children's Hospital, Columbus, Ohio.
Nationwide Children's Hospital · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundInhaled nitric oxide (iNO) is a potent pulmonary vasodilator used off-label to treat refractory hypoxemia in the pediatric intensive care unit (PICU). However, clinical practice varies widely, and there is limited evidence to support this expensive therapy. Our objective was to test whether implementation of a clinical guideline for iNO therapy would decrease practice variability, reduce ineffective iNO utilization, and control iNO-related costs.

methodsWe used quality improvement (QI) methodology to standardize the use of iNO in a single quaternary care PICU (noncardiac). All PICU patients receiving iNO therapy between January 1, 2010, and December 31, 2013, were included. The QI intervention was the development and implementation of a clinical guideline for iNO initiation, continuation, and weaning. iNO use was monitored using statistical process control charts.

resultsWe derived baseline data from 30 preguideline patients (35 separate iNO courses) compared with 33 postguideline patients (36 separate iNO courses). Despite similar baseline characteristics, disease severity, and degree of hypoxemia, postguideline patients had a shorter median [interquartile range (IQR)] duration of iNO therapy than preguideline patients [76 (48-124) hours versus 162 (87-290) hours;

conclusionsImplementation of iNO usage guidelines was associated with decreased iNO usage and cost of iNO therapy in the PICU.

Identifiers

PMID30229151
PMCPMC6132914
OpenAlexW2952380748

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.