Division of Neonatology, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA.
Arch Dis Child Fetal Neonatal Ed. 2011 Mar;96(2):F93-8. doi: 10.1136/adc.2009.178616. Epub 2010 Oct 30.
Premature newborns often experience oxygen saturations outside policy-specified targets, which may be associated with increased morbidity. Nurse workload may affect oxygen management.
To examine the relationship between number of patients assigned to neonatal intensive care unit (NICU) nurses and achievement of oxygen saturation goals in premature newborns.
The authors linked nurse-patient assignment data with continuous oxygen saturation data for infants <29 weeks' gestation in a single NICU between January and June 2008. The proportion of time oxygen saturation was in policy-specified target range (85-92%) and proportion of time hyperoxaemic (98-100%) were determined for multiple 6 h monitoring periods. Each period was characterised by a single nurse, respiratory support mode and fraction of inspired oxygen (Fio(2)) level (0.22-0.49 or ≥0.5). The nurse:patient ratio for the infant's nurse for each monitoring period was determined. Factors associated with Spo(2) target achievement and hyperoxaemia were identified.
The authors analysed 1019 monitoring periods from 14 infants with a mean (SD) birth weight of 860 (270) g and gestational age of 26.6 (1.6) weeks. The mean (range) postmenstrual age for all monitoring periods was 31.6 (24.1-40.7) weeks. Eighty-seven nurses provided care. In a multivariate cross-classified hierarchical regression, the nurse:patient ratio, postmenstrual age, respiratory support mode and Fio(2) were significantly associated with oxygen saturation outcomes. Fewer patients per nurse was significantly associated with a higher saturation target achievement among patients on high-frequency ventilation, and with reduced hyperoxaemia among patients on nasal cannula.
Fewer patients per nurse may be associated with improved achievement of oxygen saturation goals and may be an important modifiable factor influencing oxygen-related outcomes in premature newborns. This effect may vary with mode of respiratory support.
早产儿的血氧饱和度经常超出政策规定的目标范围，这可能与发病率增加有关。护士工作量可能会影响氧管理。
检查新生儿重症监护病房（NICU）护士分配给患者的人数与早产儿血氧饱和度目标达标之间的关系。
作者将护士与患者的分配数据与 2008 年 1 月至 6 月期间单 NICU 中 <29 周龄婴儿的连续血氧饱和度数据进行了关联。对于多个 6 小时监测期，确定了血氧饱和度处于政策规定目标范围内（85-92%）的时间比例和高氧血症（98-100%）的时间比例。每个监测期都有一个单一的护士、呼吸支持模式和吸入氧分数（Fio（2））水平（0.22-0.49 或≥0.5）。确定了每个监测期婴儿护士的护士与患者比例。确定了与 Spo（2）目标达标和高氧血症相关的因素。
作者分析了 14 名婴儿的 1019 个监测期，这些婴儿的平均（SD）出生体重为 860（270）g，胎龄为 26.6（1.6）周。所有监测期的平均（范围）校正后胎龄为 31.6（24.1-40.7）周。87 名护士提供了护理。在多变量交叉分类层次回归中，护士与患者比例、校正后胎龄、呼吸支持模式和 Fio（2）与血氧饱和度结果显著相关。每个护士的患者人数较少与高频通气患者的饱和度目标达标率较高相关，与鼻塞患者的高氧血症减少相关。
每个护士的患者人数较少可能与血氧饱和度目标达标率提高有关，并且可能是影响早产儿与氧相关结局的一个重要可改变因素。这种影响可能因呼吸支持模式而异。
