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Compliance in oxygen saturation targeting in preterm infants: a systematic review
Henriëtte A van Zanten1, Ratna N G B Tan2, Agnes van den Hoogen3
1Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, J6-S, PO Box 9600, 2300 RC, Leiden, The Netherlands. h.a.van_zanten@lumc.nl.
Insights
Neonatal nurses struggle with oxygen saturation targeting in preterm infants, showing low compliance. Improving training and using automated systems can enhance oxygen therapy effectiveness.
Area of Science:
- Neonatal care
- Pediatric respiratory medicine
Background:
- Oxygen therapy is crucial for preterm infants, yet optimal strategies are debated.
- Targeting oxygen saturation (SpO2) reduces mortality and morbidity in this population.
Purpose of the Study:
- To systematically review studies on compliance with SpO2 targeting in preterm infants.
- To identify factors influencing nurses' adherence to SpO2 targets.
Main Methods:
- Systematic review of qualitative and quantitative studies (2000-2015).
- Searched multiple databases including PubMed, Embase, and Cochrane.
- Included 16 studies with 2935 nurses and 574 infants.
Main Results:
- Overall compliance with SpO2 targeting in preterm infants is low.
- Nurses face difficulties maintaining SpO2 below upper alarm limits, which are often set inappropriately.
- Training, titration protocols, and reduced workload may improve compliance.
Conclusions:
- Compliance with oxygen targeting during therapy for preterm infants is suboptimal.
- Maintaining SpO2 within target ranges, particularly below the upper limit, remains a significant challenge.
Abstract:
During oxygen therapy in preterm infants, targeting oxygen saturation is important for avoiding hypoxaemia and hyperoxaemia, but this can be very difficult and challenging for neonatal nurses. We systematically reviewed the qualitative and quantitative studies investigating the compliance in targeting oxygen saturation in preterm infants and factors that influence this compliance. We searched PubMed, Embase, Web of Science, Cochrane, CINAHL and ScienceDirect from 2000 to January 2015. Sixteen studies were selected, which involved a total of 2935 nurses and 574 infants. The studies varied in methodology, and we have therefore used a narrative account to describe the data. The main finding is that there is a low compliance in oxygen targeting; the upper alarm limits are inappropriately set, and maintaining the saturation (SpO2) below the upper limit presented particular difficulties. Although there is little data available, the studies indicate that training, titration protocols and decreasing workload could improve awareness and compliance. Automated oxygen regulations have been shown to increase the time that SpO2 is within the target range.
Conclusion:
The compliance in targeting oxygen during oxygen therapy in preterm infants is low, especially in maintaining the SpO2 below the upper limit.
What Is Known:
• The use of oxygen in preterm infants is vital, but the optimal strategyremains controversial. • Targeting SpO2 during oxygen therapy in preterm infants has beenshown to reduce mortality and morbidity.
What Is New:
• Review of the literature showed that the compliance in targeting SpO2and alarm settings is low. • Creating awareness of risks of oxygen therapy and benefits in targeting,decreasing nurse/patient ratio and automated oxygen therapy couldincrease compliance.
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