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

Abstract

BackgroundVentilator 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.MethodsSingle centre, retrospective chart review that focused on oxygen and ventilator treatment practices.ResultsThe 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.ConclusionsThere 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.

Oxygen treatment of critically ill children: A lack of evidence

“…21 In order to improve oxygenation in newborns, one study found that there was no significant correlation between MAP variability and PEEP, which suggests that changing PEEP was not used as a strategy to adjust MAP. 19 Furthermore, newborns at term were at higher risk for hyperoxia than preterm, as low prevalence of high PaO 2 values in premature infants increased significantly with gestational age. 19 This could indicate greater knowledge and awareness of the toxic effect of high oxygen concentrations on the prematurely newborn, with less attention being paid to full-term newborns.…”

“…In addition we included three articles related to Neonatal Intensive Care Units (NICUs) because they answered our research question about assessment of oxygen treatment in newborns (Table 3). 19,21,40 We also included three articles that highlighted how to improve nurses' knowledge of assessing critically ill patients' oxygen requirements (Table 4). [41][42][43] The results are reported in two ways: first in tables, which summarize the key findings from each article, followed by a description of the findings.…”

“…18 However, there seems to be more awareness about the risk of hyperoxia in premature newborns and less attention is paid to full-term newborns. 19…”

“…To regulate MAP, the physician may use peak inspiratory pressure (PIP), positive endexpiratory pressure (PEEP) or inspiratory time (TI). 7,19 Since physicians have the legal responsibility for decision-making in patient treatment and the opportunity to delegate responsibility to nurses, interprofessional collaboration is a necessity. 7 To summarize, there is a great deal of information available about the significance and risks of using oxygen in premature newborns.…”

Optimal Conventional Mechanical Ventilation in Full-Term Newborns

“…Nevertheless, caution should be taken at high volume guarantees as hypocarbia may result 51 . In full term newborns, the relationship between lung physiology and mechanical ventilation treatment may not be easily understood, as a study previously demonstrated that a VT > 8 ml/kg in 310 measurements was found to have only a weak negative correlation to PaCO2 54 .…”