People and Technology in the Workplace (1991) / Chapter Skim
Currently Skimming:
Technology and Intervention in the Neonatal Intensive Care Unit
Technology and Intervention in the Neonatal Intensive Care Unit
Pages 171-188
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 171... ...
ORGANIZATION The Neonatal Intensive Care Unit (NICUJ at Babies Hospital Columbia Presbyterian Medical Center jCPMC) is a super tertiary 171
|
From page 172... ...
The Neonatal Intensive Care Unit is the central component of the network ant] contains several units that provide care to infants currently in the hospital, as well as to new patients recently born either in the center or at a network hospital.
|
From page 173... ...
They have placed the unit in the enviable position of being able to deliver superior tertiary care by providing the finances required to have the most sophisticated equipment and the manpower to operate the technology. In the new age of Diagnostic Related Groups in New York State, the financial burden for the hospital has increased geometrically, however, and fiscal constraints are being enforced.
|
From page 174... ...
The technology to be introduced was extracorporeal membrane oxygenation jECMO i. Introduction of the new technology occurred late in the historical evolution of the intensive care unit and late in the history of the current medical/nursing leadership.
|
From page 175... ...
1. ~ , ~ It essentially enables a period of lung rest oy proving an alternative source of gas exchange and oxygen delivery for an extended period of time during which the pathologic processes causing respiratory failure resolve of their own accord.
|
From page 176... ...
Once the appropriate catheters are in place the infant then receives partial cardiopulmonary bypass with the membrane oxygenator assuming the function of the damaged lung and the infant's prior respiratory support gradually decreased to minimal levels. Just before initiation of ECMO, patients are treater!
|
From page 177... ...
The application of technology in this instance involved risk taking in treating these very small infants with a previously high mortality rate and once again an unknown morbidity rate. The positive prior experience with the application of respiratory technology was an important factor in the ultimate acceptance of this more recent technology into the armamentarium of the unit.
|
From page 178... ...
To notify colleagues in other neonatal intensive care units and practicing pediatricians about the availability of the new technique, letters were sent to the directors of other neonatal programs in the tristate area. Following this mailing a young pecliatric surgeon who hack directed the program in the laboratory and who was responsible for its clinical application, began visiting neonatal intensive care units in the tristate area to discuss ECMO
|
From page 179... ...
lectures provicled colleagues in the area with an information base on which they could make decisions about their infants with respiratory failure. Based on both the internal and external discussions, a number of planning considerations emergecT before implementation.
|
From page 180... ...
In this instance infants were received from other tertiary units both within and outside our tristate area as well as from other ECMO programs outside the metropolitan area. Some tertiary units had their own transport system and thus were able to transport such infants with their own transport team.
|
From page 181... ...
Broad measures were also used to monitor the consequences of this innovation, including mortality and longitudinal morbidity, which are essential markers measuring the consequences of instituting a new therapy. In acIdition, both the pediatric surgeon involved and the hospital monitor the cost of the new innovation.
|
From page 182... ...
At times, depending on number of infants in the intensive care unit, there were not sufficient personnel to remove a nurse from the existing staff and to assign that professional to the case. Once this situation was recognized, the institution approved two new nursing positions that wouIc]
|
From page 183... ...
there was anxiety from all involved about the introduction of this change. A new unproven, unknown professional was introduced into a high-tech process, where there were great risks to the infant involved and where the medical and nursing staffs were not at ease with the technology.
|
From page 184... ...
This unexpected increase in delivery rate has stretched the resources of the neonatal intensive care unit to the point at which it has been requires] to transfer sick infants born in the institution to other neonatal intensive care units within the metropolitan area.
|
From page 185... ...
The assumption also remains among the professionals involved that a pharmacological approach to the treatment of these infants may be possible with proper investigation and research into the development of respiratory failure. ECMO programs may no longer be necessary once the key developments in research have occurred and the appropriate drugs for treatment are in place.
|
From page 186... ...
The joint leadership of the ICU ant! the ECMO program will now request outside assistance in addressing the issues that in both measurable and unmeasurable ways continue to affect on the smooth operation of the ECMO program, particularly the continuec3 staff resistance.
|
From page 187... ...
These results indicate that ECMO and lung rest are an appropriate and successful treatment for the newborn with respiratory failure that has been unresponsive to other means of treatment. The introduction of ECMO into an established neonatal intensive care unit has been successful in reducing mortality, with acceptable longitudinal outcomes for the high-risk infants.
|
From page 188... ...
1977. Extracorporeal circulation in neonatal respiratory failure jECMO)
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.