Adherence to oxygenation and ventilation targets in mechanically ventilated premature and sick newborns: a retrospective study

BMC Pediatrics

Thor Willy R Hansen¹  Ida Torunn Bjørk²  Marianne Trygg Solberg² 

[1] Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway;Department of Nursing Science, Faculty of Medicine, University of Oslo, Nedre Ullevål 9, Stjerneblokka 0850 Oslo, Norway

关键词: Oxygenation;    Mechanical ventilation;    Premature infant;    Newborn infant;   

Others  :  1144613
DOI  :  10.1186/1471-2431-13-126

 received in 2013-04-11, accepted in 2013-08-14,  发布年份 2013

【 摘 要 】

Background

Ventilator treatment exposes newborns to both hyperoxemia and hyperventilation. It is not known how common hyperoxemia and hyperventilation are in neonatal intensive care units in Norway. The purpose of this study was to assess the quality of current care by studying deviations from the target range of charted oxygenation and ventilation parameters in newborns receiving mechanical ventilation.

Methods

Single centre, retrospective chart review that focused on oxygen and ventilator treatment practices.

Results

The bedside intensive care charts of 138 newborns reflected 4978 hours of ventilator time. Arterial blood gases were charted in 1170 samples. In oxygen-supplemented newborns, high arterial pressure of oxygen (PaO₂) values were observed in 87/609 (14%) samples. In extremely premature newborns only 5% of the recorded PaO₂ values were high. Low arterial pressure of CO₂ (PaCO₂) values were recorded in 187/1170 (16%) samples, and 64 (34%) of these were < 4 kPa. Half of all low values were measured in extremely premature newborns. Tidal volumes above the target range were noted in 22% of premature and 20% of full-term newborns.

Conclusions

There was a low prevalence of high PaO₂ values in premature newborns, which increased significantly with gestational age (GA). The prevalence of low PaCO₂ values was highest among extremely premature newborns and decreased with increasing GA. Further studies are needed to identify whether adherence to oxygenation and ventilation targets can be improved by clearer communication and allocation of responsibilities between nurses and physicians.

【 授权许可】

   
2013 Solberg et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Sola A, Saldeno YP, Favareto V: Clinical practices in neonatal oxygenation: where have we failed? What can we do? J Perinatol 2008, 28(Suppl 1):S28-S34.
• [2]Solberg MT, Hansen TW, Bjork IT: Nursing assessment during oxygen administration in ventilated preterm infants. Acta Paediatr 2011, 100(2):193-197.
• [3]Muhlethaler V, Malcolm G: Mechanical ventilation in the newborn; a simplified approach.Part 1: Intermittent positive pressure ventilation. J Paediatr Child Health 2012, 48(8):649-652.
• [4]Deuber C, Terhaar M: Hyperoxia in very preterm infants: a systematic review of the literature. J Perinat Neonat Nur 2011, 25(3):268-274.
• [5]Groenendaal F, De Vooght KMK, van Bel F: Blood gas values during hypothermia in asphyxiated term neonates. Pediatrics 2009, 123(1):170-172.
• [6]Curley G, Laffey JG, Kavanagh BP: Bench-to-bedside review: carbon dioxide. Crit Care 2010, 14(2):220. BioMed Central Full Text
• [7]Thome UH, Ambalavanan N: Permissive hypercapnia to decrease lung injury in ventilated preterm neonates. Semin Fetal Neonat M 2009, 14(1):21-27.
• [8]Quine D, Stenson BJ: Arterial oxygen tension (Pao2) values in infants< 29 weeks of gestation at currently targeted saturations. Arch Dis Child-Fetal 2009, 94(1):F51-F53.
• [9]Askie LM: CURRENT OPINION optimal oxygen saturations in preterm infants: a moving target. Curr Opin Pediatr 2013, 25:000-000.
• [10]Askie LM, Brocklehurst P, Darlow BA, Finer N, Schmidt B, Tarnow-Mordi W, Ne OCG: NeOProM: neonatal oxygenation prospective meta-analysis collaboration study protocol. BMC Pediatr 2011, 11:6.
• [11]Carlo W, Finer N, Walsh M, Rich W, Gantz M, Laptook A, Yoder B, Faix R, Das A, Poole W: Target ranges of oxygen saturation in extremely preterm infants. New Engl J Med 2010, 362(21):1959.
• [12]Sola A, Rogido MR, Deulofeut R: Oxygen as a neonatal health hazard: call for detente in clinical practice. Acta Paediatr 2007, 96(6):801-812.
• [13]Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, Saugstad OD, Simeoni U, Speer CP, Halliday HL: European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants–2010 update. Neonatology 2010, 97(4):402-417.
• [14]Stenson BJ, Orme JA: The twists and turns of neonatal oxygen therapy. Early Hum Dev 2012, 88(12):961-963.
• [15]van Kaam AH, De Jaegere AP, Rimensberger PC, Debeer A, Chemin A, Norbert K, Autret F, Andreou A, Kroon A, Minić A: Incidence of hypo-and hyper-capnia in a cross-sectional European cohort of ventilated newborn infants. Arch Dis Child-Fetal 2013, 98:F323-F326.
• [16]Goldstein MR: Ventilator management: what does it all mean? Newborn Infant Nurs Rev 2006, 6(2):79-86.
• [17]Kramme R, Hoffmann K-P, Pozos RS: Springer Handbook of Medical Technology. Berlin, Heidelberg: Springer Berlin Heidelberg; 2012.
• [18]Gardner SL, Merenstein GB: Handbook of neonatal intensive care. St. Louis: Mosby; 2006.
• [19]Deulofeut R, Critz A, Adams-Chapman I, Sola A: Avoiding hyperoxia in infants < or = 1250 g is associated with improved short- and long-term outcomes. J Perinatol 2006, 26(11):700-705.
• [20]Bhutani VK, Sivieri EM: Clinical use of pulmonary mechanics and waveform graphics. Clin Perinatol 2001, 28(3):487-503. v
• [21]Fitzmaurice GM, Laird NM, Ware JH: Applied longitudinal analysis. Chichester: Wiley; 2011.
• [22]Cohen J: Statistical power analysis for the behavioral sciences. Hillsdale, N. J.: Laurence Erlbaum; 1988.
• [23]Raghuveer TS, Bloom BT: A paradigm shift in the prevention of retinopathy of prematurity. Neonatology 2011, 100(2):116-129.
• [24]van Kaam AH, Rimensberger PC, Borensztajn D, De Jaegere AP: Ventilation practices in the neonatal intensive care unit: a cross-sectional study. J Pediatr 2010, 157(5):767-771. e763
• [25]VanderVeen DK, Mansfield TA, Eichenwald EC: Lower oxygen saturation alarm limits decrease the severity of retinopathy of prematurity. J American Assoc Pediat Ophthal Strabismus 2006, 10(5):445-448.
• [26]Chow LC, Wright KW, Sola A: Can changes in clinical practice decrease the incidence of severe retinopathy of prematurity in very low birth weight infants? Pediatrics 2003, 111(2):339-345.
• [27]Saugstad OD, Aune D: In search of the optimal oxygen saturation for extremely low birth weight infants: a systematic review and meta-analysis. Neonatology 2011, 100(1):1-8.
• [28]Dawson JA, Vento M, Finer NN, Rich W, Saugstad OD, Morley CJ, Davis PG: Managing oxygen therapy during delivery room stabilization of preterm infants. J Pediatr 2012, 160(1):158-161.
• [29]Goldsmith J gJ: Neonatal intensive care unit oxygen management: a team effort. Pediatrics 2007, 119(119):1195.
• [30]Sink DW, Hope SAE, Hagadorn JI: Nurse: patient ratio and achievement of oxygen saturation goals in premature infants. Arch Dis Child-Fetal 2011, 96(2):F93-F98.
• [31]Wikstrom S, Lundin F, Ley D, Pupp IH, Fellman V, Rosen I, Hellstrom-Westas L: Carbon dioxide and glucose affect electrocortical background in extremely preterm infants. Pediatrics 2011, 127(4):e1028-e1034.
• [32]Habre W: Neonatal ventilation. Best Pract Res Clin Anaesthesiol 2010, 24(3):353-364.
• [33]Morley C: Treatment of respiratory failure: Mechanical ventilation. In Neonatology A practiacal approach to neonatal diseases. edn. Edited by Buonocore G, Bracci R, Weindling M. Milano: Springer; 2012:497-508.
• [34]Bhutani VK, Benitz WE: Pulmonary Function and Graphics. In Assisted ventilation of the neonate. 5th edition. Edited by Goldsmith JP, Karotkin EH. St. Louis, Mo: Elsevier/Saunders; 2011. 1 online resource (xvii, 631 s.): ill
• [35]Bancalari E, Claure N: Control of oxygenation during mechanical ventilation in the premature infant. Clin Perinatol 2012, 39(3):563.