About: Thresholds for oximetry alarms and target range in the NICU: an observational assessment based on likely oxygen tension and maturity

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An Entity of Type : schema:ScholarlyArticle, within Data Space : wasabi.inria.fr associated with source document(s)

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type	Academic Article research paper schema:ScholarlyArticle
isDefinedBy	Covid-on-the-Web dataset
title	Thresholds for oximetry alarms and target range in the NICU: an observational assessment based on likely oxygen tension and maturity
Creator	Bachman, Thomas Iyer, Narayan Khemani, Robinder Newth, Christopher Ross, Patrick
source	PMC
abstract	BACKGROUND: Continuous monitoring of SpO(2) in the neonatal ICU is the standard of care. Changes in SpO(2) exposure have been shown to markedly impact outcome, but limiting extreme episodes is an arduous task. Much more complicated than setting alarm policy, it is fraught with balancing alarm fatigue and compliance. Information on optimum strategies is limited. METHODS: This is a retrospective observational study intended to describe the relative chance of normoxemia, and risks of hypoxemia and hyperoxemia at relevant SpO(2) levels in the neonatal ICU. The data, paired SpO(2)-PaO(2) and post-menstrual age, are from a single tertiary care unit. They reflect all infants receiving supplemental oxygen and mechanical ventilation during a 3-year period. The primary measures were the chance of normoxemia (PaO(2) 50–80 mmHg), risks of severe hypoxemia (PaO(2) ≤ 40 mmHg), and of severe hyperoxemia (PaO(2) ≥ 100 mmHg) at relevant SpO(2) levels. RESULTS: Neonates were categorized by postmenstrual age: < 33 (n = 155), 33–36 (n = 192) and > 36 (n = 1031) weeks. From these infants, 26,162 SpO(2)-PaO(2) pairs were evaluated. The post-menstrual weeks (median and IQR) of the three groups were: 26 (24–28) n = 2603; 34 (33–35) n = 2501; and 38 (37–39) n = 21,058. The chance of normoxemia (65, 95%-CI 64–67%) was similar across the SpO(2) range of 88–95%, and independent of PMA. The increasing risk of severe hypoxemia became marked at a SpO(2) of 85% (25, 95%-CI 21–29%), and was independent of PMA. The risk of severe hyperoxemia was dependent on PMA. For infants < 33 weeks it was marked at 98% SpO(2) (25, 95%-CI 18–33%), for infants 33–36 weeks at 97% SpO(2) (24, 95%-CI 14–25%) and for those > 36 weeks at 96% SpO(2) (20, 95%-CI 17–22%). CONCLUSIONS: The risk of hyperoxemia and hypoxemia increases exponentially as SpO(2) moves towards extremes. Postmenstrual age influences the threshold at which the risk of hyperoxemia became pronounced, but not the thresholds of hypoxemia or normoxemia. The thresholds at which a marked change in the risk of hyperoxemia and hypoxemia occur can be used to guide the setting of alarm thresholds. Optimal management of neonatal oxygen saturation must take into account concerns of alarm fatigue, staffing levels, and FiO(2) titration practices.
has issue date	2020-06-27(xsd:dateTime)
bibo:doi	10.1186/s12887-020-02225-3
has license	cc-by
sha1sum (hex)	54a8c061c251952285104e86ce11f34eae84f75d
schema:url	https://doi.org/10.1186/s12887-020-02225-3
resource representing a document's title	Thresholds for oximetry alarms and target range in the NICU: an observational assessment based on likely oxygen tension and maturity
has PubMed Central identifier	PMC7320542
schema:publication	BMC Pediatr
resource representing a document's body	covid:54a8c061c251952285104e86ce11f34eae84f75d#body_text
is schema:about of	named entity 'IQR' named entity 'hypoxemia' named entity 'monitoring' named entity 'infants' named entity 'SpO' named entity 'dependent' named entity 'INCREASING' named entity '100' named entity 'REFLECT' named entity 'MECHANICAL VENTILATION' named entity 'FATIGUE' named entity 'SEVERE' named entity '29 WEEKS' named entity 'LIMITING' named entity 'RISK OF' named entity 'CHANGES' named entity 'weeks' named entity 'policy' named entity 'levels' named entity 'hypoxemia' named entity 'impact' named entity 'single' named entity 'SpO' named entity 'infants' named entity 'SpO' named entity 'SpO' named entity 'pairs' named entity 'Thresholds' named entity 'alarms' named entity 'NICU' named entity '85%' named entity 'relative chance' named entity 'neonatal' named entity 'logistic regression' named entity 'hypoxemia' named entity 'France' named entity 'false negatives' named entity 'morbidity' named entity '95% CI' named entity 'study population' named entity 'logistic regression' named entity 'retinopathy of prematurity' named entity 'buffer zone' named entity 'fetal' named entity 'menstrual age' named entity 'study population' named entity 'oxy-hemoglobin' named entity 'menstrual age' named entity 'respiratory support' named entity 'menstrual age' named entity 'hypoxemia' named entity 'dependent variable' named entity 'bioethics' named entity 'NICU' named entity 'Irvine, California' named entity 'oxygen' named entity 'hypoxemia' named entity 'mmHg' named entity 'alarm fatigue' named entity 'hypoxemia' named entity 'preterm infants' named entity 'supplemental oxygen' named entity 'Transfusions' named entity 'hypoxemia' named entity 'Arterial partial pressure of oxygen' named entity 'oxygen' named entity 'statistically significant' named entity 'transfusion' named entity 'hypoxemia' named entity 'oxygen saturation' named entity 'catheters' named entity 'oxygen saturation' named entity 'alarm fatigue' named entity 'neonates' named entity 'supplemental oxygen' named entity 'arterial blood gas' named entity 'menstrual age' named entity 'alarm fatigue' named entity 'Kruskal-Wallis test'

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