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Published in: BMC Pediatrics 1/2013

Open Access 01-12-2013 | Research article

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

Authors: Marianne Trygg Solberg, Ida Torunn Bjørk, Thor Willy R Hansen

Published in: BMC Pediatrics | Issue 1/2013

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Abstract

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.
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Literature
1.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
2.
go back to reference Solberg MT, Hansen TW, Bjork IT: Nursing assessment during oxygen administration in ventilated preterm infants. Acta Paediatr. 2011, 100 (2): 193-197. 10.1111/j.1651-2227.2010.02094.x.CrossRefPubMed Solberg MT, Hansen TW, Bjork IT: Nursing assessment during oxygen administration in ventilated preterm infants. Acta Paediatr. 2011, 100 (2): 193-197. 10.1111/j.1651-2227.2010.02094.x.CrossRefPubMed
3.
go back to reference 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. 10.1111/j.1440-1754.2010.01872.x.CrossRefPubMed 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. 10.1111/j.1440-1754.2010.01872.x.CrossRefPubMed
4.
go back to reference Deuber C, Terhaar M: Hyperoxia in very preterm infants: a systematic review of the literature. J Perinat Neonat Nur. 2011, 25 (3): 268-274. 10.1097/JPN.0b013e318226ee2c.CrossRef Deuber C, Terhaar M: Hyperoxia in very preterm infants: a systematic review of the literature. J Perinat Neonat Nur. 2011, 25 (3): 268-274. 10.1097/JPN.0b013e318226ee2c.CrossRef
5.
go back to reference Groenendaal F, De Vooght KMK, van Bel F: Blood gas values during hypothermia in asphyxiated term neonates. Pediatrics. 2009, 123 (1): 170-172. 10.1542/peds.2008-1955.CrossRefPubMed Groenendaal F, De Vooght KMK, van Bel F: Blood gas values during hypothermia in asphyxiated term neonates. Pediatrics. 2009, 123 (1): 170-172. 10.1542/peds.2008-1955.CrossRefPubMed
7.
go back to reference Thome UH, Ambalavanan N: Permissive hypercapnia to decrease lung injury in ventilated preterm neonates. Semin Fetal Neonat M. 2009, 14 (1): 21-27. 10.1016/j.siny.2008.08.005.CrossRef Thome UH, Ambalavanan N: Permissive hypercapnia to decrease lung injury in ventilated preterm neonates. Semin Fetal Neonat M. 2009, 14 (1): 21-27. 10.1016/j.siny.2008.08.005.CrossRef
8.
go back to reference 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.CrossRef 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.CrossRef
9.
go back to reference Askie LM: CURRENT OPINION optimal oxygen saturations in preterm infants: a moving target. Curr Opin Pediatr. 2013, 25: 000-000.CrossRef Askie LM: CURRENT OPINION optimal oxygen saturations in preterm infants: a moving target. Curr Opin Pediatr. 2013, 25: 000-000.CrossRef
10.
go back to reference 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-PubMedPubMedCentral 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-PubMedPubMedCentral
11.
go back to reference 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-CrossRefPubMed 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-CrossRefPubMed
12.
go back to reference 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. 10.1111/j.1651-2227.2007.00287.x.CrossRefPubMed 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. 10.1111/j.1651-2227.2007.00287.x.CrossRefPubMed
13.
go back to reference 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. 10.1159/000297773.CrossRefPubMed 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. 10.1159/000297773.CrossRefPubMed
14.
go back to reference Stenson BJ, Orme JA: The twists and turns of neonatal oxygen therapy. Early Hum Dev. 2012, 88 (12): 961-963. 10.1016/j.earlhumdev.2012.09.003.CrossRefPubMed Stenson BJ, Orme JA: The twists and turns of neonatal oxygen therapy. Early Hum Dev. 2012, 88 (12): 961-963. 10.1016/j.earlhumdev.2012.09.003.CrossRefPubMed
15.
go back to reference 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. 10.1136/archdischild-2012-302649.CrossRef 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. 10.1136/archdischild-2012-302649.CrossRef
16.
go back to reference Goldstein MR: Ventilator management: what does it all mean?. Newborn Infant Nurs Rev. 2006, 6 (2): 79-86. 10.1053/j.nainr.2006.03.003.CrossRef Goldstein MR: Ventilator management: what does it all mean?. Newborn Infant Nurs Rev. 2006, 6 (2): 79-86. 10.1053/j.nainr.2006.03.003.CrossRef
17.
go back to reference Kramme R, Hoffmann K-P, Pozos RS: Springer Handbook of Medical Technology. 2012, Berlin, Heidelberg: Springer Berlin Heidelberg Kramme R, Hoffmann K-P, Pozos RS: Springer Handbook of Medical Technology. 2012, Berlin, Heidelberg: Springer Berlin Heidelberg
18.
go back to reference Gardner SL, Merenstein GB: Handbook of neonatal intensive care. 2006, St. Louis: Mosby Gardner SL, Merenstein GB: Handbook of neonatal intensive care. 2006, St. Louis: Mosby
19.
go back to reference 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. 10.1038/sj.jp.7211608.CrossRefPubMed 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. 10.1038/sj.jp.7211608.CrossRefPubMed
20.
go back to reference Bhutani VK, Sivieri EM: Clinical use of pulmonary mechanics and waveform graphics. Clin Perinatol. 2001, 28 (3): 487-503. 10.1016/S0095-5108(05)70102-0. vCrossRefPubMed Bhutani VK, Sivieri EM: Clinical use of pulmonary mechanics and waveform graphics. Clin Perinatol. 2001, 28 (3): 487-503. 10.1016/S0095-5108(05)70102-0. vCrossRefPubMed
21.
go back to reference Fitzmaurice GM, Laird NM, Ware JH: Applied longitudinal analysis. 2011, Chichester: Wiley Fitzmaurice GM, Laird NM, Ware JH: Applied longitudinal analysis. 2011, Chichester: Wiley
22.
go back to reference Cohen J: Statistical power analysis for the behavioral sciences. 1988, Hillsdale, N. J.: Laurence Erlbaum Cohen J: Statistical power analysis for the behavioral sciences. 1988, Hillsdale, N. J.: Laurence Erlbaum
23.
go back to reference Raghuveer TS, Bloom BT: A paradigm shift in the prevention of retinopathy of prematurity. Neonatology. 2011, 100 (2): 116-129. 10.1159/000322848.CrossRefPubMed Raghuveer TS, Bloom BT: A paradigm shift in the prevention of retinopathy of prematurity. Neonatology. 2011, 100 (2): 116-129. 10.1159/000322848.CrossRefPubMed
24.
go back to reference 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. 10.1016/j.jpeds.2010.05.043. e763CrossRefPubMed 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. 10.1016/j.jpeds.2010.05.043. e763CrossRefPubMed
25.
go back to reference 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. 10.1016/j.jaapos.2006.04.010.CrossRef 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. 10.1016/j.jaapos.2006.04.010.CrossRef
26.
go back to reference 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. 10.1542/peds.111.2.339.CrossRefPubMed 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. 10.1542/peds.111.2.339.CrossRefPubMed
27.
go back to reference 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. 10.1159/000322001.CrossRefPubMed 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. 10.1159/000322001.CrossRefPubMed
28.
go back to reference 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. 10.1016/j.jpeds.2011.07.045.CrossRefPubMed 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. 10.1016/j.jpeds.2011.07.045.CrossRefPubMed
29.
go back to reference Goldsmith J gJ: Neonatal intensive care unit oxygen management: a team effort. Pediatrics. 2007, 119 (119): 1195-CrossRefPubMed Goldsmith J gJ: Neonatal intensive care unit oxygen management: a team effort. Pediatrics. 2007, 119 (119): 1195-CrossRefPubMed
30.
go back to reference 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. 10.1136/adc.2009.178616.CrossRef 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. 10.1136/adc.2009.178616.CrossRef
31.
go back to reference 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. 10.1542/peds.2010-2755.CrossRefPubMed 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. 10.1542/peds.2010-2755.CrossRefPubMed
32.
33.
go back to reference Morley C: Treatment of respiratory failure: Mechanical ventilation. Neonatology A practiacal approach to neonatal diseases. edn. Edited by: Buonocore G, Bracci R, Weindling M. 2012, Milano: Springer, 497-508. Morley C: Treatment of respiratory failure: Mechanical ventilation. Neonatology A practiacal approach to neonatal diseases. edn. Edited by: Buonocore G, Bracci R, Weindling M. 2012, Milano: Springer, 497-508.
34.
go back to reference Bhutani VK, Benitz WE: Pulmonary Function and Graphics. Assisted ventilation of the neonate. Edited by: Goldsmith JP, Karotkin EH. 2011, St. Louis, Mo: Elsevier/Saunders, 1 online resource (xvii, 631 s.): ill, 5 Bhutani VK, Benitz WE: Pulmonary Function and Graphics. Assisted ventilation of the neonate. Edited by: Goldsmith JP, Karotkin EH. 2011, St. Louis, Mo: Elsevier/Saunders, 1 online resource (xvii, 631 s.): ill, 5
35.
go back to reference Bancalari E, Claure N: Control of oxygenation during mechanical ventilation in the premature infant. Clin Perinatol. 2012, 39 (3): 563-10.1016/j.clp.2012.06.013.CrossRefPubMed Bancalari E, Claure N: Control of oxygenation during mechanical ventilation in the premature infant. Clin Perinatol. 2012, 39 (3): 563-10.1016/j.clp.2012.06.013.CrossRefPubMed
Metadata
Title
Adherence to oxygenation and ventilation targets in mechanically ventilated premature and sick newborns: a retrospective study
Authors
Marianne Trygg Solberg
Ida Torunn Bjørk
Thor Willy R Hansen
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2013
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/1471-2431-13-126

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