Adherence to oxygenation and ventilation targets in mechanically ventilated premature and sick newborns: a retrospective study

BACKGROUND: Ventilator treatment exposes newborns to both hyperoxemia and hyperventilation. It is not known how common hyperoxemia and hyperventilation are in neonatal intensive care units in Norway. The purpose of this study was to assess the quality of current care by studying deviations from the target range of charted oxygenation and ventilation parameters in newborns receiving mechanical ventilation. METHODS: Single centre, retrospective chart review that focused on oxygen and ventilator treatment practices. RESULTS: The bedside intensive care charts of 138 newborns reflected 4978 hours of ventilator time. Arterial blood gases were charted in 1170 samples. In oxygen-supplemented newborns, high arterial pressure of oxygen (PaO(2)) values were observed in 87/609 (14%) samples. In extremely premature newborns only 5% of the recorded PaO(2) values were high. Low arterial pressure of CO(2) (PaCO(2)) values were recorded in 187/1170 (16%) samples, and 64 (34%) of these were < 4 kPa. Half of all low values were measured in extremely premature newborns. Tidal volumes above the target range were noted in 22% of premature and 20% of full-term newborns. CONCLUSIONS: There was a low prevalence of high PaO(2) values in premature newborns, which increased significantly with gestational age (GA). The prevalence of low PaCO(2) values was highest among extremely premature newborns and decreased with increasing GA. Further studies are needed to identify whether adherence to oxygenation and ventilation targets can be improved by clearer communication and allocation of responsibilities between nurses and physicians.