2010 OPEN FORUM Abstracts
LOW OXYGEN SATURATION TARGETING AND ITS EFFECT ON NEONATAL BRONCHOPULMONARY DYSPLASIA AND RETINOPATHY OF PREMATURITY: IMPLEMENTATION AND ANALYSIS.
Matthew S. Pavlichko1,2, Felicia Lombardo2, David Sorrentino2; 1Respiratory Care Services, The Reading Hospital and Medical Center, West Reading, PA; 2NICU, The Reading Hospital and Medical Center, West Reading, PA
Background: Hyperoxia in the very low birth weight infant has been determined to an exacerbating cause of bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP). The use of oxygen saturation targeting in neonatal intensive care units is widely used but the exact parameters for saturation ranges are uncertain. This study will discuss how our NICU implemented an oxygen saturation targeting protocol and the resulting patient data following implementation. Method: Oxygen saturation levels were determined through a literature review to define best practice. The established goal of the protocol: maintain saturations at therapeutic and safe levels; curtail unnecessary oxygen use, administration, and minimize abrupt changes in FiO2. Training was delivered to all NICU staff prior to the start of the protocol and intermittently for re-emphasis. Saturations were maintained in the target parameter of 88-92% with alarm settings at + 2%. Randomized weekly quality improvement audits were performed to ensure alarm and protocol compliance. All patients < 1500g at birth were included and data was measured through the Vermont Oxford Network (VON). Outcome data for ROP, BPD, and home oxygen use were measured and compared to an internal historical control and VON data. BPD was defined as oxygen use at 28 days of life or 36 weeks post menstrual age, both of which were looked at independently. Results: Occurrence of patients on oxygen at 28 days or at 36 weeks showed no significant change with the protocol. But a 43.75% decrease was noted on patients discharged on home oxygen. ROP surgery necessity decreased 75% when the patients oxygen saturations were targeted per protocol. Stage severity of ROP shifted with a decrease in ROP Stage 3 of 68.75% and an increase in Stage 0-2. Conclusion: Implementing an oxygen targeting protocol reduced the need for home oxygen and decreased ROP severity. We speculate that limiting oxygen exposure decreased inflammatory response to oxygen free radical injury. Sponsored Research - None Oxygen Saturation Targeting Protocol: Outcome data Percent alarm compliance per protocol by staff was 90.5%.