Clark Rowena L, Lui Kei, Oei Ju Lee
Department of Newborn Care, Royal Hospital for Women, New South Wales, Australia.
J Paediatr Child Health. 2009 Jan-Feb;45(1-2):31-5. doi: 10.1111/j.1440-1754.2008.01430.x.
The aim of this paper was to explore the opinions and practices of tertiary health-care professionals in Australia and New Zealand regarding air and oxygen blending (OB) for the resuscitation of preterm infants.
Structured questionnaires were sent to the directors of 25 tertiary perinatal units, with instructions to distribute the questionnaires to 15 pertinent clinical staff.
Response rate was 72% (n = 271); medical-staff response was 25%. Sixteen (64%) perinatal units had OB resuscitation equipment. Among respondents, 114 (42%) had access to OB and 73 (27%) had OB for all resuscitations. Pulse oximetry was available to 160 (59%) of respondents. The majority (173, 64%) would initiate resuscitation with Fractional inspired oxygen (FiO(2)) ranging from 0.3 to 0.9 (mean 0.5), with 15% and 21% preferring air and 100% oxygen, respectively. There were large variations in managing FiO(2) changes thereafter. Half of the respondents were either unsure (39%) or not convinced (15%) that 100% oxygen during resuscitation would cause harm. Conversely, 42% suggested that OB might improve outcome with bronchopulmonary dysplasia and retinopathy of prematurity being the most important considerations. Most (92%) would advocate for OB in the delivery suite. Set-up cost (50%) and lack of guided experience (38%) ranked highest as barriers to change.
Two-thirds of the tertiary centres have at least some OB equipment in the delivery suite, but the ways and opinions in which OB is utilised differ widely. Most practitioners would advocate for a change. There is an urgent need for further research to achieve a consistent and meaningful clinical management for OB resuscitation of preterm infants.
本文旨在探讨澳大利亚和新西兰三级医疗保健专业人员对用于早产儿复苏的空气与氧气混合（OB）的看法和做法。
向25个三级围产医学单位的主任发送结构化问卷，并指示他们将问卷分发给15名相关临床工作人员。
回复率为72%（n = 271）；医务人员的回复率为25%。16个（64%）围产医学单位拥有OB复苏设备。在受访者中，114人（42%）可使用OB，73人（27%）在所有复苏中都使用OB。160名（59%）受访者可使用脉搏血氧饱和度仪。大多数人（173人，64%）会使用吸入氧分数（FiO₂）在0.3至0.9之间（平均0.5）开始复苏，分别有15%和21%的人更喜欢使用空气和100%氧气。此后在管理FiO₂变化方面存在很大差异。一半的受访者要么不确定（39%），要么不相信（15%）复苏期间使用100%氧气会造成伤害。相反，42%的人认为OB可能会改善结局，其中最重要的考虑因素是支气管肺发育不良和早产儿视网膜病变。大多数人（92%）会在产房提倡使用OB。设置成本（50%）和缺乏指导经验（38%）被列为变革的最大障碍。
三分之二的三级中心产房至少有一些OB设备，但OB的使用方式和看法差异很大。大多数从业者会提倡进行变革。迫切需要进一步研究，以实现对早产儿OB复苏的一致且有意义的临床管理。
