title: Less invasive ventilation in extremely low birth weight infants from 1997 to 2011: survey versus evidence.
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.
  
  
  BACKGROUND
  • 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.
  
  
  BACKGROUND
  • 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.
authors.affiliation: Division of Neonatology, University Children's Hospital Inselspital Bern, 3010, Bern, Switzerland, roland.gerull@insel.ch.
authors.forename: Roland
authors.initials: R
authors.lastname: Gerull
authors.forename: Helen
authors.initials: H
authors.lastname: Manser
authors.forename: Helmut
authors.initials: H
authors.lastname: Küster
authors.forename: Tina
authors.initials: T
authors.lastname: Arenz
authors.forename: Stephan
authors.initials: S
authors.lastname: Arenz
authors.forename: Mathias
authors.initials: M
authors.lastname: Nelle
mesh_terms: D001317:Austria / Q000453:epidemiology; D005260:Female; D005544:Forecasting; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007385:Intermittent Positive-Pressure Ventilation / Q000379:methods*; D008297:Male; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000628:therapy*; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends; D013557:Switzerland / Q000453:epidemiology
references.citation: Cochrane Database Syst Rev. 2014 Sep 04;(9):CD003212
references.pmid: 25188554
references.citation: Pediatrics. 2005 Dec;116(6):1353-60
references.pmid: 16322158
references.citation: Arch Pediatr Adolesc Med. 2007 Nov;161(11):1082-7
references.pmid: 17984411
references.citation: Pediatrics. 1999 Nov;104(5 Pt 1):1082-8
references.pmid: 10545551
references.citation: Crit Care Med. 2012 Feb;40(2):441-9
references.pmid: 22001584
references.citation: Acta Paediatr. 2013 Dec;102(12):1154-9
references.pmid: 24102836
references.citation: Neonatology. 2010;98(4):354-64
references.pmid: 20980772
references.citation: N Engl J Med. 2010 May 27;362(21):1959-69
references.pmid: 20472937
references.citation: Neonatology. 2011;100(3):219-27
references.pmid: 21701210
references.citation: Neonatology. 2014;105(1):55-63
references.pmid: 24247112
references.citation: Crit Care Med. 2006 May;34(5):1311-8
references.pmid: 16557151
references.citation: Arch Dis Child Fetal Neonatal Ed. 2013 Jan;98(1):F32-6
references.pmid: 22684163
references.citation: Pediatrics. 2000 Jun;105(6):1216-26
references.pmid: 10835060
references.citation: BMC Pediatr. 2012 Feb 22;12:17
references.pmid: 22356724
references.citation: J Perinatol. 2006 May;26(5):279-85
references.pmid: 16554847
references.citation: Pediatrics. 2013 Aug;132(2):222-8
references.pmid: 23858426
references.citation: Am J Dis Child. 1986 Nov;140(11):1125-30
references.pmid: 3532762
references.citation: Acta Paediatr. 2009 May;98(5):786-91
references.pmid: 19243354
references.citation: N Engl J Med. 2000 May 4;342(18):1301-8
references.pmid: 10793162
references.citation: Pediatr Res. 1988 Aug;24(2):175-9
references.pmid: 3141892
references.citation: Arch Dis Child. 1981 Jun;56(6):425-31
references.pmid: 7259272
references.citation: Biometrics. 2001 Sep;57(3):963-71
references.pmid: 11550951
references.citation: N Engl J Med. 2011 Apr 28;364(17):1680-2
references.pmid: 21524227
references.citation: Cochrane Database Syst Rev. 2009 Jan 21;(1):CD001077
references.pmid: 19160188
references.citation: J Pediatr. 2010 Nov;157(5):767-71.e1-3
references.pmid: 20619854
references.citation: Lancet. 2012 Jun 9;379(9832):2162-72
references.pmid: 22682464
references.citation: Semin Fetal Neonatal Med. 2009 Dec;14(6):374-82
references.pmid: 19736053
references.citation: JAMA Pediatr. 2013 Sep;167(9):873
references.pmid: 24026787
references.citation: Early Hum Dev. 1990 Aug;23(2):129-37
references.pmid: 2124183
references.citation: JAMA. 2013 May 22;309(20):2111-20
references.pmid: 23644995
references.citation: Arch Dis Child. 1982 Jun;57(6):410-7
references.pmid: 7092304
references.citation: Crit Care Med. 2005 Jan;33(1):1-6; discussion 230-2
references.pmid: 15644641
references.citation: Arch Dis Child Fetal Neonatal Ed. 2013 Jul;98(4):F323-6
references.pmid: 23241364
references.citation: N Engl J Med. 2013 Aug 15;369(7):611-20
references.pmid: 23944299