Oxygen saturation targeting in preterm infants receiving continuous positive airway pressure
Date
2014
Authors
Lim, K.
Wheeler, K.
Gale, T.
Jackson, H.
Kihlstrand, J.
Sand, C.
Dawson, J.
Dargaville, P.
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Journal article
Citation
Journal of Pediatrics, 2014; 164(4):730-736.e1
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Kathleen Lim, Kevin I. Wheeler, Timothy J. Gale, Hamish D. Jackson, Jonna F. Kihlstrand, Cajsa Sand, Jennifer A. Dawson, and Peter A. Dargaville
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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.
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Copyright © 2014 Mosby Inc. All rights reserved.