Buckmaster Adam G, Wright Ian M R, Arnolda Gaston, Henderson-Smart David J
Northern Sydney Central Coast Area Health Service, Gosford Hospital, Gosford, NSW, Australia.
J Paediatr Child Health. 2007 Jun;43(6):469-75. doi: 10.1111/j.1440-1754.2007.01113.x.
In Australian hospitals: (i) to identify current practices in the initial oxygen management of infants with respiratory distress; (ii) to identify factors important in deciding to transfer an infant; and (iii) to identify thresholds for transfer.
All Australian hospitals with: >200 registered deliveries, a special care unit (SCU) or neonatal intensive care unit (NICU), and at least one paediatrician were surveyed in 2004 (n=176). The questionnaire sought information on the initial oxygen management and factors important in deciding to transfer. Three scenarios were also used to identify thresholds for pH, carbon dioxide and oxygen levels at which transfer should occur. Responses from SCU were compared with those from NICU.
15/19 (79%) NICUs and 118/157 (75%) SCUs responded. Initial oxygen management varies widely among SCUs and NICUs. NICUs set significantly lower saturation (SaO(2)) targets in two of the three scenarios. NICUs are statistically significantly more likely to regard 'Medical Staff Experience' and 'Time to Nearest NICU' as important compared with SCUs (P<0.05). NICUs would 'Probably' and 'Definitely Transfer' infants at significantly lower oxygen levels in all three cases (P<0.05). SCUs are significantly less likely to transfer babies with pH of <7.25 compared with NICUs. There was no difference between the centres for CO(2) level.
The wide variation that exists between nurseries in the initial management of infants with respiratory distress and in the thresholds for transfer strongly suggests the need for the development of practice guidelines.
在澳大利亚医院中：（i）确定对呼吸窘迫婴儿进行初始氧疗的当前做法；（ii）确定决定转运婴儿的重要因素；（iii）确定转运阈值。
2004年对所有符合以下条件的澳大利亚医院进行了调查（n = 176）：登记分娩数>200例、设有特殊护理病房（SCU）或新生儿重症监护病房（NICU）且至少有一名儿科医生。问卷旨在获取有关初始氧疗管理及决定转运的重要因素的信息。还使用了三种情景来确定应进行转运的pH值、二氧化碳和氧气水平阈值。将SCU的回复与NICU的回复进行比较。
19家NICU中有15家（79%）、157家SCU中有118家（75%）进行了回复。SCU和NICU之间初始氧疗管理差异很大。在三种情景中的两种情景下，NICU设定的饱和度（SaO₂）目标显著更低。与SCU相比，NICU在统计学上更有可能将“医务人员经验”和“到最近NICU的时间”视为重要因素（P<0.05）。在所有三种情况下，NICU在显著更低的氧水平时“可能”和“肯定会转运”婴儿（P<0.05）。与NICU相比，SCU将pH值<7.25的婴儿转运的可能性显著更低。各中心在二氧化碳水平方面没有差异。
在呼吸窘迫婴儿的初始管理及转运阈值方面，各托儿所之间存在很大差异，这强烈表明需要制定实践指南。
