Improving manual oxygen titration in preterm infants by training and guideline implementation

Henriëtte A van Zanten, Steffen C Pauws, Evelien C Beks, Ben J Stenson, Enrico Lopriore, Arjan B Te Pas

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Abstract

To study oxygen saturation (SpO2) targeting before and after training and guideline implementation of manual oxygen titration, two cohorts of preterm infants <30 weeks of gestation needing respiratory support and oxygen therapy were compared. The percentage of the time spent with SpO2 within the target range (85-95%) was calculated (%SpO2-wtr). SpO2 was collected every minute when oxygen is >21%. ABCs where oxygen therapy was given were identified and analyzed. After training and guideline implementation the %SpO2-wtr increased (median interquartile range (IQR)) 48.0 (19.6-63.9) % vs 61.9 (48.5-72.3) %; p < 0.005, with a decrease in the %SpO2 > 95% (44.0 (27.8-66.2) % vs 30.8 (22.6-44.5) %; p < 0.05). There was no effect on the %SpO2 < 85% (5.9 (2.8-7.9) % vs 6.2 (2.5-8) %; ns) and %SpO2 < 80% (1.9 (1.0-3.0) % vs 1.7 (0.8-2.6) %; ns). In total, 186 ABCs with oxygen therapy before and 168 ABCs after training and guideline implementation occurred. The duration of SpO2 < 80% reduced (2 (1-2) vs 1 (1-2) minutes; p < 0.05), the occurrence of SpO2 > 95% did not decrease (73% vs 64%; ns) but lasted shorter (2 (0-7) vs 1 (1-3) minute; p < 0.004).

CONCLUSION: Training and guideline implementation in manual oxygen titration improved SpO2 targeting in preterm infants with more time spent within the target range and less frequent hyperoxaemia. The durations of hypoxaemia and hyperoxaemia during ABCs were shorter. What is Known: • Oxygen saturation targeting in preterm infants can be challenging and the compliance is low when oxygen is titrated manually. • Hyperoxaemia often occurs after oxygen therapy for oxygen desaturation during apnoeas. What is New: • Training and implementing guidelines improved oxygen saturation targeting and reduced hyperoxaemia. • Training and implementing guidelines improved manual oxygen titration during ABC.

Original languageEnglish
Pages (from-to)99-107
Number of pages9
JournalEuropean Journal of Pediatrics
Volume176
Issue number1
DOIs
Publication statusPublished - Jan 2017

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Premature Infants
Oxygen
Compliance

Keywords

  • Female
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases
  • Intensive Care, Neonatal
  • Male
  • Neonatal Nursing
  • Oximetry
  • Oxygen
  • Oxygen Inhalation Therapy
  • Practice Guidelines as Topic
  • Prospective Studies
  • Retrospective Studies
  • Journal Article
  • Observational Study

Cite this

van Zanten, Henriëtte A ; Pauws, Steffen C ; Beks, Evelien C ; Stenson, Ben J ; Lopriore, Enrico ; Te Pas, Arjan B. / Improving manual oxygen titration in preterm infants by training and guideline implementation. In: European Journal of Pediatrics. 2017 ; Vol. 176, No. 1. pp. 99-107.
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abstract = "To study oxygen saturation (SpO2) targeting before and after training and guideline implementation of manual oxygen titration, two cohorts of preterm infants <30 weeks of gestation needing respiratory support and oxygen therapy were compared. The percentage of the time spent with SpO2 within the target range (85-95{\%}) was calculated ({\%}SpO2-wtr). SpO2 was collected every minute when oxygen is >21{\%}. ABCs where oxygen therapy was given were identified and analyzed. After training and guideline implementation the {\%}SpO2-wtr increased (median interquartile range (IQR)) 48.0 (19.6-63.9) {\%} vs 61.9 (48.5-72.3) {\%}; p < 0.005, with a decrease in the {\%}SpO2 > 95{\%} (44.0 (27.8-66.2) {\%} vs 30.8 (22.6-44.5) {\%}; p < 0.05). There was no effect on the {\%}SpO2 < 85{\%} (5.9 (2.8-7.9) {\%} vs 6.2 (2.5-8) {\%}; ns) and {\%}SpO2 < 80{\%} (1.9 (1.0-3.0) {\%} vs 1.7 (0.8-2.6) {\%}; ns). In total, 186 ABCs with oxygen therapy before and 168 ABCs after training and guideline implementation occurred. The duration of SpO2 < 80{\%} reduced (2 (1-2) vs 1 (1-2) minutes; p < 0.05), the occurrence of SpO2 > 95{\%} did not decrease (73{\%} vs 64{\%}; ns) but lasted shorter (2 (0-7) vs 1 (1-3) minute; p < 0.004).CONCLUSION: Training and guideline implementation in manual oxygen titration improved SpO2 targeting in preterm infants with more time spent within the target range and less frequent hyperoxaemia. The durations of hypoxaemia and hyperoxaemia during ABCs were shorter. What is Known: • Oxygen saturation targeting in preterm infants can be challenging and the compliance is low when oxygen is titrated manually. • Hyperoxaemia often occurs after oxygen therapy for oxygen desaturation during apnoeas. What is New: • Training and implementing guidelines improved oxygen saturation targeting and reduced hyperoxaemia. • Training and implementing guidelines improved manual oxygen titration during ABC.",
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Improving manual oxygen titration in preterm infants by training and guideline implementation. / van Zanten, Henriëtte A; Pauws, Steffen C; Beks, Evelien C; Stenson, Ben J; Lopriore, Enrico; Te Pas, Arjan B.

In: European Journal of Pediatrics, Vol. 176, No. 1, 01.2017, p. 99-107.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Improving manual oxygen titration in preterm infants by training and guideline implementation

AU - van Zanten, Henriëtte A

AU - Pauws, Steffen C

AU - Beks, Evelien C

AU - Stenson, Ben J

AU - Lopriore, Enrico

AU - Te Pas, Arjan B

PY - 2017/1

Y1 - 2017/1

N2 - To study oxygen saturation (SpO2) targeting before and after training and guideline implementation of manual oxygen titration, two cohorts of preterm infants <30 weeks of gestation needing respiratory support and oxygen therapy were compared. The percentage of the time spent with SpO2 within the target range (85-95%) was calculated (%SpO2-wtr). SpO2 was collected every minute when oxygen is >21%. ABCs where oxygen therapy was given were identified and analyzed. After training and guideline implementation the %SpO2-wtr increased (median interquartile range (IQR)) 48.0 (19.6-63.9) % vs 61.9 (48.5-72.3) %; p < 0.005, with a decrease in the %SpO2 > 95% (44.0 (27.8-66.2) % vs 30.8 (22.6-44.5) %; p < 0.05). There was no effect on the %SpO2 < 85% (5.9 (2.8-7.9) % vs 6.2 (2.5-8) %; ns) and %SpO2 < 80% (1.9 (1.0-3.0) % vs 1.7 (0.8-2.6) %; ns). In total, 186 ABCs with oxygen therapy before and 168 ABCs after training and guideline implementation occurred. The duration of SpO2 < 80% reduced (2 (1-2) vs 1 (1-2) minutes; p < 0.05), the occurrence of SpO2 > 95% did not decrease (73% vs 64%; ns) but lasted shorter (2 (0-7) vs 1 (1-3) minute; p < 0.004).CONCLUSION: Training and guideline implementation in manual oxygen titration improved SpO2 targeting in preterm infants with more time spent within the target range and less frequent hyperoxaemia. The durations of hypoxaemia and hyperoxaemia during ABCs were shorter. What is Known: • Oxygen saturation targeting in preterm infants can be challenging and the compliance is low when oxygen is titrated manually. • Hyperoxaemia often occurs after oxygen therapy for oxygen desaturation during apnoeas. What is New: • Training and implementing guidelines improved oxygen saturation targeting and reduced hyperoxaemia. • Training and implementing guidelines improved manual oxygen titration during ABC.

AB - To study oxygen saturation (SpO2) targeting before and after training and guideline implementation of manual oxygen titration, two cohorts of preterm infants <30 weeks of gestation needing respiratory support and oxygen therapy were compared. The percentage of the time spent with SpO2 within the target range (85-95%) was calculated (%SpO2-wtr). SpO2 was collected every minute when oxygen is >21%. ABCs where oxygen therapy was given were identified and analyzed. After training and guideline implementation the %SpO2-wtr increased (median interquartile range (IQR)) 48.0 (19.6-63.9) % vs 61.9 (48.5-72.3) %; p < 0.005, with a decrease in the %SpO2 > 95% (44.0 (27.8-66.2) % vs 30.8 (22.6-44.5) %; p < 0.05). There was no effect on the %SpO2 < 85% (5.9 (2.8-7.9) % vs 6.2 (2.5-8) %; ns) and %SpO2 < 80% (1.9 (1.0-3.0) % vs 1.7 (0.8-2.6) %; ns). In total, 186 ABCs with oxygen therapy before and 168 ABCs after training and guideline implementation occurred. The duration of SpO2 < 80% reduced (2 (1-2) vs 1 (1-2) minutes; p < 0.05), the occurrence of SpO2 > 95% did not decrease (73% vs 64%; ns) but lasted shorter (2 (0-7) vs 1 (1-3) minute; p < 0.004).CONCLUSION: Training and guideline implementation in manual oxygen titration improved SpO2 targeting in preterm infants with more time spent within the target range and less frequent hyperoxaemia. The durations of hypoxaemia and hyperoxaemia during ABCs were shorter. What is Known: • Oxygen saturation targeting in preterm infants can be challenging and the compliance is low when oxygen is titrated manually. • Hyperoxaemia often occurs after oxygen therapy for oxygen desaturation during apnoeas. What is New: • Training and implementing guidelines improved oxygen saturation targeting and reduced hyperoxaemia. • Training and implementing guidelines improved manual oxygen titration during ABC.

KW - Female

KW - Gestational Age

KW - Humans

KW - Infant, Newborn

KW - Infant, Premature

KW - Infant, Premature, Diseases

KW - Intensive Care, Neonatal

KW - Male

KW - Neonatal Nursing

KW - Oximetry

KW - Oxygen

KW - Oxygen Inhalation Therapy

KW - Practice Guidelines as Topic

KW - Prospective Studies

KW - Retrospective Studies

KW - Journal Article

KW - Observational Study

U2 - 10.1007/s00431-016-2811-x

DO - 10.1007/s00431-016-2811-x

M3 - Article

VL - 176

SP - 99

EP - 107

JO - European Journal of Pediatrics

JF - European Journal of Pediatrics

SN - 0340-6199

IS - 1

ER -