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Improving manual oxygen titration in preterm infants by training and guideline implementation
van Zanten,Henriëtte A Pauws,Steffen C Beks,Evelien C Stenson,Ben J Lopriore,Enrico Te Pas,Arjan B
van Zanten,Henriëtte A
Pauws,Steffen C
Beks,Evelien C
Stenson,Ben J
Lopriore,Enrico
Te Pas,Arjan B
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 SpO2 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. What is New: • Training and implementing guidelines improved oxygen saturation targeting and reduced hyperoxaemia. • Training and implementing guidelines improved manual oxygen titration during ABC.
Description
Date
2017-01
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Volume Title
Publisher
Research Projects
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Keywords
Female, Gestational Age, Humans, Infant, Newborn, Infant, Premature, Infant, Premature, Diseases, Intensive Care, Neonatal, Male, Neonatal Nursing, Oximetry, Oxygen, Oxygen Inhalation Therapy, Practice Guidelines as Topic, Prospective Studies, Retrospective Studies, Journal Article, Observational Study
Citation
van Zanten, H A, Pauws, S C, Beks, E C, Stenson, B J, Lopriore, E & Te Pas, A B 2017, 'Improving manual oxygen titration in preterm infants by training and guideline implementation', European Journal of Pediatrics, vol. 176, no. 1, pp. 99-107. https://doi.org/10.1007/s00431-016-2811-x