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Less invasive ventilation in extremely low birth weight infants from 1997 to 2011: survey versus evidence

Gerull, Roland ; Manser, Helen ; Küster, Helmut ; Arenz, Tina ; Arenz, Stephan ; Nelle, Mathias

European Journal of Pediatrics, 2015, Vol.174(9), pp.1189-1196 [Peer Reviewed Journal]

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  • Title:
    Less invasive ventilation in extremely low birth weight infants from 1997 to 2011: survey versus evidence
  • Author: Gerull, Roland ; Manser, Helen ; Küster, Helmut ; Arenz, Tina ; Arenz, Stephan ; Nelle, Mathias
  • Subjects: Preterm ; ELBW ; Survey ; Oxygen saturation ; CO ; pH ; Ventilation
  • Is Part Of: European Journal of Pediatrics, 2015, Vol.174(9), pp.1189-1196
  • Description: Evidence for target values of arterial oxygen saturation (SaO 2 ), CO 2 , 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 SaO 2 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 CO 2 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 SaO decreased, while CO and pH increased significantly during the observation period. Current values largely reflect available evidence at time of the surveys.
  • Language: English
  • Identifier: ISSN: 0340-6199 ; E-ISSN: 1432-1076 ; DOI: 10.1007/s00431-015-2519-3
  • Source: Springer Science & Business Media B.V.

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