The Science Journal of the American Association for Respiratory Care

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.

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