Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic.
, Lake Arrowhead, USA.
BMC Pediatr. 2020 Jun 27;20(1):317. doi: 10.1186/s12887-020-02225-3.
Continuous monitoring of SpO in the neonatal ICU is the standard of care. Changes in SpO 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.
This is a retrospective observational study intended to describe the relative chance of normoxemia, and risks of hypoxemia and hyperoxemia at relevant SpO levels in the neonatal ICU. The data, paired SpO-PaO 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 50-80 mmHg), risks of severe hypoxemia (PaO ≤ 40 mmHg), and of severe hyperoxemia (PaO ≥ 100 mmHg) at relevant SpO levels.
Neonates were categorized by postmenstrual age: < 33 (n = 155), 33-36 (n = 192) and > 36 (n = 1031) weeks. From these infants, 26,162 SpO-PaO 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 range of 88-95%, and independent of PMA. The increasing risk of severe hypoxemia became marked at a SpO 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 (25, 95%-CI 18-33%), for infants 33-36 weeks at 97% SpO (24, 95%-CI 14-25%) and for those > 36 weeks at 96% SpO (20, 95%-CI 17-22%).
The risk of hyperoxemia and hypoxemia increases exponentially as SpO 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 titration practices.
新生儿 ICU 中持续监测 SpO 是标准的护理方法。SpO 暴露的变化已被证明对结果有显著影响，但限制极端情况是一项艰巨的任务。这比设置警报策略要复杂得多，充满了平衡警报疲劳和合规性的挑战。有关最佳策略的信息有限。
这是一项回顾性观察研究，旨在描述新生儿 ICU 中相关 SpO 水平下的氧合正常、低氧血症和高氧血症的相对机会，以及相关风险。数据是配对的 SpO-PaO 和胎龄，来自于一个单一的三级护理单位。它们反映了所有在 3 年期间接受补充氧气和机械通气的婴儿。主要测量指标是在相关 SpO 水平下氧合正常（PaO 50-80mmHg）、严重低氧血症（PaO≤40mmHg）和严重高氧血症（PaO≥100mmHg）的机会。
根据胎龄将新生儿分为：<33 周（n=155）、33-36 周（n=192）和>36 周（n=1031）周。从这些婴儿中评估了 26162 对 SpO-PaO。三组的胎龄（中位数和 IQR）分别为：26 周（24-28）n=2603；34 周（33-35）n=2501；和 38 周（37-39）n=21058。在 88-95%的 SpO 范围内，氧合正常（65%，95%-CI 64-67%）的机会相似，且与胎龄无关。严重低氧血症的风险在 SpO 为 85%时显著增加（25%，95%-CI 21-29%），且与胎龄无关。严重高氧血症的风险取决于胎龄。对于<33 周的婴儿，风险在 SpO 为 98%时明显增加（25%，95%-CI 18-33%），对于 33-36 周的婴儿在 SpO 为 97%时明显增加（24%，95%-CI 14-25%），对于>36 周的婴儿在 SpO 为 96%时明显增加（20%，95%-CI 17-22%）。
随着 SpO 向极端值移动，高氧血症和低氧血症的风险呈指数级增加。胎龄影响高氧血症风险显著增加的阈值，但不影响低氧血症或氧合正常的阈值。高氧血症和低氧血症风险显著变化的阈值可用于指导警报阈值的设置。新生儿氧饱和度的最佳管理必须考虑到警报疲劳、人员配备水平和 FiO 滴定实践的担忧。
