Oxygen saturation and outcomes in preterm infants the boost ii United Kingdom, Australia, and New Zealand collaborative groups

Khadawardi, Emad; Al-Hazzani, Fahad

doi:10.4103/2249-4847.116404

Cited by 21 publications

(18 citation statements)

References 7 publications

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“…Evaluate and modify SANS escalation algorithms. Although both high and low SpO 2 are quantitatively associated with harm in vulnerable populations over time, [7][8][9] the immediate need to decrease false alarms required careful consideration of the secondary notification system algorithms. Because low SpO 2 and heart rate changes can be immediately associated with poor patient outcome (ie, death), and because the intervals for escalation are arbitrarily determined, changes were first made to the high SpO 2 alarm escalation algorithm.…”

Section: Planning the Initiativementioning

confidence: 99%

“…[7][8][9] Among many changes, narrowed alarm parameters based on gestational age were adopted. SpO 2 alarm frequency was a predetermined balancing measure, with prospective data collection of SpO 2 alarms beginning in May 2012 and retrospectively available from December 2011.…”

Section: Figurementioning

confidence: 99%

“…Mott Children's Hospital NICU at the University of Michigan during implementation of new oxygen management guidelines that focused on oxygen targeting to reduce severe retinopathy of prematurity (ROP). [7][8][9] The guidelines included narrowing of oxygen saturation alarms measured by pulse oximetry (SpO 2 ) to maximize time spent within a target range. Bedside SpO 2 alarms and signals from our secondary alert notification system (SANS) escalated during initial evaluation.…”

mentioning

confidence: 99%

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Balancing the Tension Between Hyperoxia Prevention and Alarm Fatigue in the NICU

Ketko

Martin²,

Nemshak³

et al. 2015

Pediatrics

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BACKGROUND: After the implementation of narrowed oxygen saturation alarms, alarm frequency increased in the C.S. Mott Children's Hospital NICU which could have a negative impact on patient safety. The Joint Commission on the Accreditation of Healthcare Organizations issued a Sentinel Event Alert for hospitals in 2013 to improve alarm safety, resulting in a 2014 National Patient Safety Goal requiring institutional policies and procedures to be in place to manage alarms.METHODS: A multidisciplinary improvement team developed an alarm management bundle applying strategies to decrease alarm frequency, which included evaluating existing strategies and developing patient care-based and systems-based interventions. The total number of delivered and detected saturation alarms and high saturation alarms and the total time spent within a targeted saturation range were quantitatively tracked. Nursing morale was assessed qualitatively.RESULTS: SpO 2 alarms per monitored patient-day increased from 78 to 105 after the narrowing of alarm limits. Modification of the high saturation alarm algorithm substantially decreased the delivery and escalation of high pulse oxygen saturation (SpO 2 ) alarms. During a pilot period, using histogram technology to individually customize alarm limits resulted in increased time spent within the targeted saturation range and fewer alarms per day. Qualitatively, nurses reported improved satisfaction when not assigned

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Section: Planning the Initiativementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

mentioning

confidence: 99%

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Balancing the Tension Between Hyperoxia Prevention and Alarm Fatigue in the NICU

Ketko

Martin²,

Nemshak³

et al. 2015

Pediatrics

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“…Although BPD is a multifactorial disease, a major factor in its etiology is the extended use of supplemental oxygen (65). Numerous large-scale epidemiological studies have shown that use of supplemental oxygen is associated with BPD (2,31,37,57,61). Prolonged inhalation of hyperoxic gas can lead to the accumulation of reactive oxygen species (ROS) within the developing lung and ultimately a state of oxidative stress.…”

mentioning

confidence: 99%

Neonatal exposure to mild hyperoxia causes persistent increases in oxidative stress and immune cells in the lungs of mice without altering lung structure

Bouch

O’Reilly

Harding

et al. 2015

American Journal of Physiology-Lung Cellular and Molecular Phys

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Preterm infants often require supplemental oxygen due to lung immaturity, but hyperoxia can contribute to an increased risk of respiratory illness later in life. Our aim was to compare the effects of mild and moderate levels of neonatal hyperoxia on markers of pulmonary oxidative stress and inflammation and on lung architecture; both immediate and persistent effects were assessed. Neonatal mice (C57BL6/J) were raised in either room air (21% O2), mild (40% O2), or moderate (65% O2) hyperoxia from birth until postnatal day 7 (P7d). The mice were killed at either P7d (immediate effects) or lived in air until adulthood (P56d, persistent effects). We enumerated macrophages in lung tissue at P7d and immune cells in bronchoalveolar lavage fluid (BALF) at P56d. At P7d and P56d, we assessed pulmonary oxidative stress [heme oxygenase-1 (HO-1) and nitrotyrosine staining] and lung architecture. The data were interrogated for sex differences. At P7d, HO-1 gene expression was greater in the 65% O2 group than in the 21% O2 group. At P56d, the area of nitrotyrosine staining and number of immune cells were greater in the 40% O2 and 65% O2 groups relative to the 21% O2 group. Exposure to 65% O2, but not 40% O2, led to larger alveoli and lower tissue fraction in the short term and to persistently fewer bronchiolar-alveolar attachments. Exposure to 40% O2 or 65% O2 causes persistent increases in pulmonary oxidative stress and immune cells, suggesting chronic inflammation within the adult lung. Unlike 65% O2, 40% O2 does not affect lung architecture.

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“…Both the higher and the lower levels are within the range of oxygenation levels provided by clinicians as part of “usual care” at the institutions at which the research was conducted . Similar studies were performed internationally: the Canadian Oxygen Trial at institutions in Canada, the United States, Argentina, Finland, Israel, and Germany; and the Benefits of Oxygen Saturation Targeting (BOOST) trials at institutions in the United Kingdom, New Zealand, and Australia . In all of the studies, infants suffered higher rates of retinopathy at the higher range of oxygen targets and lower rates of retinopathy at the lower oxygen targets, but there was a higher rate of mortality in the lower oxygen group in the SUPPORT and BOOST studies.…”

Section: Introductionmentioning

confidence: 78%

Were There “Additional Foreseeable Risks” in the SUPPORT Study? Lessons Not Learned from the ARDSnet Clinical Trials

Silverman¹,

Dreyfuss²

2014

Hastings Center Report

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Oxygen saturation and outcomes in preterm infants the boost ii United Kingdom, Australia, and New Zealand collaborative groups

Cited by 21 publications

References 7 publications

Balancing the Tension Between Hyperoxia Prevention and Alarm Fatigue in the NICU

Balancing the Tension Between Hyperoxia Prevention and Alarm Fatigue in the NICU

Neonatal exposure to mild hyperoxia causes persistent increases in oxidative stress and immune cells in the lungs of mice without altering lung structure

Were There “Additional Foreseeable Risks” in the SUPPORT Study? Lessons Not Learned from the ARDSnet Clinical Trials

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