Compliance in oxygen saturation targeting in preterm infants: a systematic review

Abstract

During oxygen therapy in preterm infants, targeting oxygen saturation is important for avoiding hypoxaemia and hyperoxaemia, but this can be very difficult and challenging for neonatal nurses. We systematically reviewed the qualitative and quantitative studies investigating the compliance in targeting oxygen saturation in preterm infants and factors that influence this compliance. We searched PubMed, Embase, Web of Science, Cochrane, CINAHL and ScienceDirect from 2000 to January 2015. Sixteen studies were selected, which involved a total of 2935 nurses and 574 infants. The studies varied in methodology, and we have therefore used a narrative account to describe the data. The main finding is that there is a low compliance in oxygen targeting; the upper alarm limits are inappropriately set, and maintaining the saturation (SpO2) below the upper limit presented particular difficulties. Although there is little data available, the studies indicate that training, titration protocols and decreasing workload could improve awareness and compliance. Automated oxygen regulations have been shown to increase the time that SpO2 is within the target range.Conclusion: The compliance in targeting oxygen during oxygen therapy in preterm infants is low, especially in maintaining the SpO2 below the upper limit. What is Known: • The use of oxygen in preterm infants is vital, but the optimal strategy remains controversial. • Targeting SpO 2 during oxygen therapy in preterm infants has been shown to reduce mortality and morbidity. What is New:• Review of the literature showed that the compliance in targeting SpO 2 and alarm settings is low. • Creating awareness of risks of oxygen therapy and benefits in targeting, decreasing nurse/patient ratio and automated oxygen therapy could increase compliance.

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

“…When the higher target range and tighter alarm limits were applied to our cohort, the SpO 2 was within target range for half of the time, in line with previous studies (20)(21)(22). Factors that might have influenced compliance in oxygen saturation targeting were discussed in a review by van Zanten et al (23). Studies have shown that when nurses had more patients to care for, this resulted in patients spending less time within the target range and more time above the target range (24,25).…”

“…Factors that might have influenced compliance in oxygen saturation targeting were discussed in a review by van Zanten et al. . Studies have shown that when nurses had more patients to care for, this resulted in patients spending less time within the target range and more time above the target range .…”

Pulse oximeter saturation target limits for preterm infants: a survey among European neonatal intensive care units

“…Oxygen is one of the most widely used drugs in the care of (very) preterm infants, and arterial oxygen saturation measured by pulse oximetry (SpO 2 ) is the standard, noninvasive, continuous method used to guide oxygen therapy [6, 17, 18]. However, for preterm infants requiring supplemental oxygen, the optimum range of SpO 2 to minimize organ damage, without causing hypoxic injury, remains controversial [9, 10].…”

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

“…There is a tension between narrower alarm limits, which increase alarm frequency, nurse fatigue and potential wider fluctuations in saturation and wider limits which may expose infants to potentially longer periods of time outside the desired range [74]. Even in the best units many babies spend much time outside the target range, more usually hyperoxic than hypoxic [75,76]. Secondary analysis of data from the COT trial oximeters showed an association of prolonged episodes of hypoxaemia (saturation <80% for >1 min) with later death or adverse neurodevelopmental outcome [77].…”