2004 OPEN FORUM Abstracts
COMPARISON OF PaCO2 VALUES BEFORE AND AFTER THE IMPLEMENTATION OF A PATIENT DRIVEN HIGH FREQUENCY OSCILLATORY VENTILATION (HFOV) PROTOCOL IN A NICU
-David Flaherty RRT,
Calvin Clark RRT, Anne Ramirez MSN, RNC, Terrence F. Smith RRT, Bob
Vassian MS, MBA, Donna Cravener BSN RN, Barbara Prieur RRT, Les Foss
RRT, Drew Litzenberger MD, Brian Wood MD, Mission Hospital’s,
Asheville, NC
Background: Wide variations in PaCO2 values have
been shown to be associated with adverse neurological outcomes such
as periventricular leukomalacia and intracranial hemorrhage in
ventilated newborn infants. The implementation of a HFOV Protocol
could reduce the fluctuation or variance in PaCO2 values. We expected
to see a reduction in the variation of the PaCO2 values post
implementation.
Method: This was a retrospective study with
historical controls. All patients studied weighed ≤ 1500 grams.
Using blood gases obtained during the first 24 hours of life, we
collected PaCO2 values from eight patients during the first four
months preceding the implementation of a patient-driven HFOV
Protocol. Four months following the implementation of the HFOV
Protocol we again collected PaCO2 values from nine patients during
the first 24 hours of life. We evaluated PaCO2 values pre and post
implementation of the HFOV Protocol to determine the protocol’s
effect on PaCO2 values and variance and used a two sample F-test to
evaluate our hypothesis.
Results: The mean PaCO2 measurements
were similar for both pre and post implementation groups (pre=36.29,
post =38.90). We stated our null hypothesis – that there was no
difference in variance between the pre and post implementation
groups. The F- test indicated that the reduction in variation from
92.36 (pre) to 52.24 (post) was statistically significant with a p =
.016.
Conclusion: The statistically significant reduction in
variance and similar mean PaCO2 values between groups suggest that
the use of HFOV Protocols in NICU may provide better patient care.