title: An observational study to quantify manual adjustments of the inspired oxygen fraction in extremely low birth weight infants.
abstract: OBJECTIVE
  To quantify manual fraction of inspired oxygen (FiO(2)) adjustments performed by caregivers in extremely low birth weight (ELBW; ≤1000 g) infants, in relation to oxygen saturation (SpO(2)) and bedside care.
  
  
  METHODS
  In a single-centre study, FiO(2) , SpO(2) and alarm limits of ELBW infants were collected for 3 days continuously, while caregivers were filmed. A descriptive analysis, focused on manual FiO(2) adjustments, was performed.
  
  
  RESULTS
  Twelve ELWB infants were included. Total recording time was 726 h. FiO(2) was increased 851 times and decreased 1309 times; median (range) step size was 5% (1% to 65%) and -3% (-1% to -65%), respectively. Wide variation of FiO(2) adjustments for equal levels of SpO(2) was observed in all included infants. One hundred and twenty-six of 136 FiO(2) adjustments with a step size ≥15% and 111 of 171 desaturations <70% were associated with medical or nursing procedures. When FiO(2) was >21%, alarm limits for SpO(2) were set according to protocol (88-94%) in 64% of the time. Within these periods, SpO(2) was >94% for 30% and <88% for 16% of the time.
  
  
  CONCLUSIONS
  Manual FiO(2) adjustments varied widely in frequency and step size. Deep desaturations and large FiO(2) adjustments were associated with medical or nursing procedures. When large adjustments are really necessary, it will be challenging to implement them in an automatic adjustment device.
authors: Department of BioMechanical Engineering, Faculty of Mechanical, Maritime & Materials Engineering, Delft University of Technology, The Netherlands. a.c.vandereijk@tudelft.nl
authors: Anne Catherine
authors: AC
authors: van der Eijk
authors: Jenny
authors: J
authors: Dankelman
authors: Sander
authors: S
authors: Schutte
authors: Huibert Jan
authors: HJ
authors: Simonsz
authors: Bert Johan
authors: BJ
authors: Smit
mesh_terms: D019983:Guideline Adherence; D006801:Humans; D052577:Infant, Extremely Low Birth Weight / Q000097:blood*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood*; D015931:Intensive Care, Neonatal / Q000379:methods*; D010092:Oximetry; D010102:Oxygen Inhalation Therapy / Q000379:methods* / Q000451:nursing / Q000592:standards; D017410:Practice Guidelines as Topic; D057184:Practice Patterns, Nurses'; D010818:Practice Patterns, Physicians'; D014741:Video Recording