Gerull Roland, Manser Helen, Küster Helmut, Arenz Tina, Arenz Stephan, Nelle Mathias
Division of Neonatology, University Children's Hospital Inselspital Bern, 3010, Bern, Switzerland,
Eur J Pediatr. 2015 Sep;174(9):1189-96. doi: 10.1007/s00431-015-2519-3. Epub 2015 Apr 1.
Evidence for target values of arterial oxygen saturation (SaO2), CO2, and pH has changed substantially over the last 20 years. A representative survey concerning treatment strategies in extremely low-birth-weight infants (ELBW) was sent to all German neonatal intensive care units (NICUs) treating ELBW infants in 1997. A follow-up survey was conducted in 2011 and sent to all NICUs in Germany, Austria, and Switzerland. During the observation period, NICUs targeting SaO2 of 80, 85, and 90 % have increased, while units aiming for 94 and 96 % decreased (all p < 0.001). Similarly, NICUs aiming for pH 7.25 or lower increased, while 7.35 or higher decreased (both p < 0.001). Furthermore, more units targeted a CO2 of 50 mmHg (7.3 kPa) or higher (p < 0.001), while fewer targeted 40 or 35 mmHg (p < 0.001). Non-invasive ventilation (NIV) was used in 80.2 % of NICUs in 2011. The most frequently used ventilation modes were synchronized intermittent mandatory ventilation (SIMV) (67.5 %) and intermittent positive pressure ventilation (IPPV) (59.7 %) in 1997 and SIMV (77.2 %) and synchronized intermittent positive pressure ventilation (SIPPV) (26.8 %) in 2011. NICUs reporting frequent or always use of IPPV decreased to 11.0 % (p < 0.001). SIMV (77.2 %) and SIPPV (26.8 %) did not change from 1997 to 2011, while high-frequency oscillation (HFO) increased from 9.1 to 19.7 % (p = 0.018). Differences between countries, level of care, and size of the NICU were minimal.
Target values for SaO2 decreased, while CO2 and pH increased significantly during the observation period. Current values largely reflect available evidence at time of the surveys.
• Evidence concerning target values of oxygen saturation, CO 2 , and pH in extremely low-birth-weight infants has grown substantially. • It is not known to which extent this knowledge is transferred into clinical practice and if treatment strategies have changed.
• Target values for oxygen saturation in ELBW infants decreased between 1997 and 2011 while target values for CO 2 and pH increased. • Similar treatment strategies existed in different countries, hospitals of different size, or university versus nonuniversity hospitals in 2011.
在过去20年里，动脉血氧饱和度（SaO2）、二氧化碳（CO2）及pH值的目标值证据已发生显著变化。1997年，针对所有治疗极低出生体重儿（ELBW）的德国新生儿重症监护病房（NICU）开展了一项关于治疗策略的代表性调查。2011年进行了随访调查，并发送给德国、奥地利和瑞士的所有NICU。在观察期内，将SaO2目标设定为80%、85%和90%的NICU数量增加，而目标为94%和96%的单位数量减少（所有p<0.001）。同样，将pH值目标设定为7.25或更低的NICU数量增加，而设定为7.35或更高的数量减少（两者p<0.001）。此外，更多单位将CO2目标设定为50 mmHg（7.3 kPa）或更高（p<0.001），而将目标设定为40或35 mmHg的单位减少（p<0.001）。2011年，80.2%的NICU使用了无创通气（NIV）。1997年最常用的通气模式是同步间歇指令通气（SIMV）（67.5%）和间歇正压通气（IPPV）（59.7%），2011年是SIMV（77.2%）和同步间歇正压通气（SIPPV）（26.8%）。报告经常或总是使用IPPV的NICU减少至11.0%（p<0.001）。1997年至2011年，SIMV（77.2%）和SIPPV（26.8%）没有变化，而高频振荡（HFO）从9.1%增加到19.7%（p = 0.018）。国家、护理水平和NICU规模之间的差异极小。
在观察期内，SaO2目标值降低，而CO2和pH值显著升高。当前值很大程度上反映了调查时的现有证据。
• 关于极低出生体重儿氧饱和度、CO2和pH值目标值的证据大幅增加。
• 尚不清楚这一知识在多大程度上转化为临床实践以及治疗策略是否发生了变化。
• 1997年至2011年期间，ELBW婴儿的氧饱和度目标值降低，而CO2和pH值目标值升高。
• 2011年，不同国家、不同规模的医院或大学医院与非大学医院存在相似的治疗策略。
