Published in:
Open Access
01-01-2017 | Original Article
Improving manual oxygen titration in preterm infants by training and guideline implementation
Authors:
Henriëtte A. van Zanten, Steffen C. Pauws, Evelien C. Beks, Ben J. Stenson, Enrico Lopriore, Arjan B. te Pas
Published in:
European Journal of Pediatrics
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Issue 1/2017
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Abstract
To study oxygen saturation (SpO2) targeting before and after training and guideline implementation of manual oxygen titration, two cohorts of preterm infants <30 weeks of gestation needing respiratory support and oxygen therapy were compared. The percentage of the time spent with SpO2 within the target range (85–95%) was calculated (%SpO2-wtr). SpO2 was collected every minute when oxygen is >21%. ABCs where oxygen therapy was given were identified and analyzed. After training and guideline implementation the %SpO2-wtr increased (median interquartile range (IQR)) 48.0 (19.6–63.9) % vs 61.9 (48.5–72.3) %; p < 0.005, with a decrease in the %SpO2 > 95% (44.0 (27.8–66.2) % vs 30.8 (22.6–44.5) %; p < 0.05). There was no effect on the %SpO2 < 85% (5.9 (2.8–7.9) % vs 6.2 (2.5–8) %; ns) and %SpO2 < 80% (1.9 (1.0–3.0) % vs 1.7 (0.8–2.6) %; ns). In total, 186 ABCs with oxygen therapy before and 168 ABCs after training and guideline implementation occurred. The duration of SpO2 < 80% reduced (2 (1–2) vs 1 (1–2) minutes; p < 0.05), the occurrence of SpO2 > 95% did not decrease (73% vs 64%; ns) but lasted shorter (2 (0–7) vs 1 (1–3) minute; p < 0.004).
Conclusion: Training and guideline implementation in manual oxygen titration improved SpO
2 targeting in preterm infants with more time spent within the target range and less frequent hyperoxaemia. The durations of hypoxaemia and hyperoxaemia during ABCs were shorter.
What
is Known:
• Oxygen saturation targeting in preterm infants can be challenging and the compliance is low when oxygen is titrated manually.
• Hyperoxaemia often occurs after oxygen therapy for oxygen desaturation during apnoeas.
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What is New:
• Training and implementing guidelines improved oxygen saturation targeting and reduced hyperoxaemia.
• Training and implementing guidelines improved manual oxygen titration during ABC.
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