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

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Abstract

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.

Conclusions: 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.

What is Known:

• 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.

What is New:

• 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.

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Abbreviations

BIPAP:

Biphasic positive airway pressure ventilation

BPD:

Bronchopulmonary dysplasia

ELBW:

Extremely low birth weight, less than 1000 g

FiO2 :

Fraction of inspired oxygen

GA:

Gestational age

GNPI:

Gesellschaft für Neonatologie und pädiatrische Intensivmedizin, Society of Neonatology and Pediatric Intensive Care

IVH:

Intraventricular hemorrhage

IMV:

Intermittent mandatory ventilation

IPPV:

Intermittent positive pressure ventilation

NICU:

Neonatal intensive care unit

NIV:

Non invasive ventilation

pCO2 :

Partial pressure of carbon dioxide

PEEP:

Positive end expiratory pressure

PiP:

Peak inspiratory pressure

RDS:

Respiratory distress syndrome

SaO2 :

Arterial oxygen saturation

SIMV:

Synchronized intermittent mandatory ventilation

SIPPV:

Synchronized Intermittent positive pressure ventilation

VG:

Volume guarantee ventilation

VLBW:

Very low birth weight, less than 1500 g

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Conflict of interest

The authors have no conflicts of interest relevant to this article to disclose.

Funding

No sources of external funding

Authors’ contributions

The authors contributed to the manuscript in the following way: Roland Gerull was involved in the design of the second questionnaire, center recruitment, and data analysis and wrote the manuscript. Helen Manser was responsible for the second questionnaire in terms of design, development of the database, and data management and center recruitment. Tina Arenz was responsible for development and realization of the first survey. Helmut Küster supervised the development and contributed to the realization of the first survey. Stephan Arenz was responsible for center recruitment, development of the database of the second questionnaire, and data analysis and wrote parts of the manuscript. Mathias Nelle supervised the development and realization of the second survey, acquired hospital funds for the incentive, and was involved in writing the manuscript. All authors have participated in the concept and design, analysis and interpretation of data, and drafting or revising of the manuscript and contributed in discussions, reviews, and corrections of the submitted manuscript. All listed authors on the manuscript have seen and approved the submitted version of the manuscript and take full responsibility for the manuscript.

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Authors and Affiliations

  1. Division of Neonatology, University Children’s Hospital Inselspital Bern, 3010, Bern, Switzerland

    Roland Gerull, Helen Manser, Stephan Arenz & Mathias Nelle

  2. Department of Pediatrics, University Children’s Hospital Inselspital Bern, 3010, Bern, Switzerland

    Tina Arenz

  3. Division of Neonatology, University Children’s Hospital Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Germany

    Helmut Küster

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  1. Roland Gerull
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Correspondence to Roland Gerull.

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Communicated by Patrick Van Reempts

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Gerull, R., Manser, H., Küster, H. et al. Less invasive ventilation in extremely low birth weight infants from 1997 to 2011: survey versus evidence. Eur J Pediatr 174, 1189–1196 (2015). https://doi.org/10.1007/s00431-015-2519-3

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