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Oxygen saturation targeting in preterm infants receiving continuous positive airway pressure

Citation

Lim, K and Wheeler, K and Gale, TJ and Jackson, HD and Kihlstrand, JF and Sand, C and Dawson, JA and Dargaville, PA, Oxygen saturation targeting in preterm infants receiving continuous positive airway pressure, The Journal of Pediatrics, 164, (4) pp. 730-736. ISSN 0022-3476 (2014) [Refereed Article]

Copyright Statement

Copyright 2014 Mosby Inc.

DOI: doi:10.1016/j.jpeds.2013.11.072

Abstract

Objective: The precision of oxygen saturation (SpO2) targeting in preterm infants on continuous positive airway pressure (CPAP) is incompletely characterized. We therefore evaluated SpO2 targeting in infants solely receiving CPAP, aiming to describe their SpO2 profile, to document the frequency of prolonged hyperoxia and hypoxia episodes and of fraction of inspired oxygen (FiO2) adjustments, and to explore the relationships with neonatal intensive care unit operational factors.

Study design: Preterm infants <37 weeks' gestation in 2 neonatal intensive care units were studied if they were receiving CPAP and in supplemental oxygen at the beginning of each 24-hour recording. SpO2, heart rate, and FiO2 were recorded (sampling interval 1-2 seconds). We measured the proportion of time spent in predefined SpO2 ranges, the frequency of prolonged episodes (≥30 seconds) of SpO2 deviation, and the effect of operational factors including nurse-patient ratio.

Results: A total of 4034 usable hours of data were recorded from 45 infants of gestation 30 (27-32) weeks (median [IQR]). When requiring supplemental oxygen, infants were in the target SpO2 range (88%-92%) for only 31% (19%-39%) of total recording time, with 48 (6.9-90) episodes per 24 hours of severe hyperoxia (SpO2 ≥98%), and 9.0 (1.6-21) episodes per 24 hours of hypoxia (SpO2 <80%). An increased frequency of prolonged hyperoxia in supplemental oxygen was noted when nurses were each caring for more patients. Adjustments to FiO2 were made 25 (16-41) times per day.

Conclusion: SpO2 targeting is challenging in preterm infants receiving CPAP support, with a high proportion of time spent outside the target range and frequent prolonged hypoxic and hyperoxic episodes.

Item Details

Item Type:Refereed Article
Keywords:CPAP, continuous positive airway pressure, FiO2, fraction of inspired oxygen, HR, heart rate, NICU, neonatal intensive care unit, RHH, Royal Hobart Hospital, RWH, Royal Women's Hospital, SpO2, oxygen saturation
Research Division:Engineering
Research Group:Biomedical Engineering
Research Field:Biomedical Engineering not elsewhere classified
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Respiratory System and Diseases (incl. Asthma)
Author:Lim, K (Ms Lim)
Author:Wheeler, K (Dr Kevin Wheeler)
Author:Gale, TJ (Dr Timothy Gale)
Author:Jackson, HD (Mr Hamish Jackson)
Author:Dargaville, PA (Professor Peter Dargaville)
ID Code:89636
Year Published:2014
Web of Science® Times Cited:35
Deposited By:Engineering
Deposited On:2014-03-11
Last Modified:2017-11-03
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