Adherence to oxygen saturation targets increased in preterm infants when a higher target range and tighter alarm limits were introduced

Abstract

Aim European consensus guidelines published in May 2013 recommended a target peripheral capillary oxygen saturation (SpO2) range of 90–95% for preterm infants. These were incorporated into guidelines at the Karolinska University Hospital, Sweden, in November 2013. This study compared clinical practice before and after those local guidelines. Methods We included infants who were born between 23 + 0 and 30 + 6 weeks from January 1, 2013 to December, 31 2015 and received intensive care in two Karolinska units. The lower saturation target of 88–92% and alarm limits of 85–95% used before November 2013 were compared to the new higher saturation target of 90–95% and alarm limits of 89–96%. Results Data from 399 infants were analysed. The mean SpO2 was 92.4% with the higher target (n = 301) and 91.1% with the lower target (n = 98). Using the higher instead of lower target meant that the SpO2 was within the prescribed target range more frequently (51% versus 30%) and the proportion of time with SpO2 >95% was increased by 9% (95% confidence interval 7–11%, p < 0.001). Conclusion The higher saturation target and tighter alarm limits led to higher mean oxygen saturation, increased adherence to the target and increased time with hyperoxaemia.

Accuracy of pulse oximetry in preterm and term infants is insufficient to determine arterial oxygen saturation and tension

“…The risk of hypoxaemia decreased, but the risk of hyperoxaemia increased. 20,21 Interestingly, this change only marginally altered the risk of the PaO 2 exceeding 10.7 kPa.…”

“…The appropriate definition of a safe PaO 2 target range remains uncertain. Several authors have used a range of 5.3-10.7 kPa (40-80 mm Hg), [18][19][20][21][22] but others proposed an upper limit of 12 kPa (90 mm Hg). 23,24 Using the former definition, PaO 2 values were less likely outside the target range (18.5%) compared to SpO 2 and SaO 2 readings raising the question of whether the defined target range is too wide.…”

Highlights in this issue

“…European consensus guidelines published in May 2013 recommended a target peripheral capillary oxygen saturation range of 90–95% for preterm infants. Klevebro et al compared clinical practice before and after these were incorporated into local guidelines at Karolinska University Hospital, Sweden, in November 2013 . Higher saturation target and tighter alarm limits led to higher mean oxygen saturation and greater adherence to the targets, but increased the time with hyperoxaemia.…”

The oxygen dilemma: oxygen saturation targets in preterm infants

“…In this issue of Acta Paediatrica , Klevebro et al report the results from a retrospective study carried out in Stockholm before and after the 2013 European consensus guidelines were integrated into local practice at the Karolinska Institutet. The study comprised 399 infants born between 23 and 30 weeks of gestation who received supplemental oxygen during the first three weeks of life.…”

“…Klevebro et al found that the higher SpO2 target range resulted in less time with hypoxaemia. The late effects of intermittent hypoxaemia were addressed in a post hoc analysis by the Canadian Oxygen Trial and were associated with an increased risk of late death or disability at 18 months of age, suggesting that further preventative research is needed .…”