Patterns of practice in neonatal and pediatric respiratory care

Because little information has been available regarding common respiratory care practices in neonatology and pediatrics, it has been difficult to develop departmental standards of care. We therefore conducted a national survey of current practices, hoping to establish whether any de facto standards exist in the U.S.

A 47-item multiple-choice survey instrument was mailed in 1988 to 689 U.S. hospitals that included all neonatal and perinatal high-risk centers.

Response was received from 323 hospitals, for a 47% response rate. Some de facto standards do seem to exist, notably (1) q 2 h ventilator checks, (2) continuous measurement of oxygen concentration in oxygen hoods and ventilator circuits, (3) staffing ratio of four ventilator patients to one respiratory care practitioner, and (4) changing of ventilator circuits q 48 h.

While we do not claim that such de facto standards have a scientific basis, we suggest that respiratory care services whose practices vary from the de facto standards should investigate why their own practices differ and whether they can be justified.