Alarm limits

Mira · Jul 21, 2003

There is a controversy about alarm limits and I would like to know as well.In our unit,we usually set the Sao2 limit at 88-98%,ncpap@21%FiO2 with poor CO2 at 88-100% we are slow on weaning the baby out of O2 though, probably related to our limits.Where I used to work b4,the manager will be mad at you if she sees that the baby is on O2@10-20cc,she will ask you what`s that for?And when the baby has no record of desaturation within 24-48hours the saturation monitor will be switched-off(this apply to those special care babies).

dawngloves, BSN, RN · Jul 22, 2003

Our monitors are defaulted to have a high of 96%, but you'd be hard pressed to find one we didn't over ride. It's a real PITA to have it alarm when you have a baby on 25% o2 and if you tweak 'em to 23% they plummet. I'm not gonna stand there and screw around with a monitor all day. If they are 100% and stable I'll turn them down.

NicuGal, MSN, RN · Jul 22, 2003

HR's are usually 100-200, with the full termers or kids with low resting HR's set lower. Have to have an order to go out of those parameters. Our apnea is 20 seconds. Pulseox...there is a huge contraversy with that....many of our attendings go by the accept lower sats, save the eyes and others don't. We have to have specific PO reading orders. Most tiny ones we accept sats of 80 or better...no more randomly turning up O's. Our alarm volume has to be set at 70%.

CatRN · Jul 31, 2003

Hi there.....

Different NICU's vary.....especially who is up on the current research. Let it be known that, O2 toxicity that causes any damage to the eyes (detached retina), must be an arterial oxygen concentration greater than 200 for prolonged periods of time. But as many of you know, to manage our PPHN kids, we keep the PaO2 very high, usually around this range to maintain adequate oxygenation of the blood being shunted....so fix the eyes later, save the baby now.

Most places have a variation with the type of ventilation being used. Intubated kids are usually kept between 88-92%, chronic vented kids as low as 80%. Some places keep them all set at 85-100%. If the baby requires oxygen, than he/she shouldn't be sat'ing 100% because the O2 should be weaned. Current literature suggests that by accepting lower SpO2 we are preventing CLD and BPD and reducing the need for prolonged O2 use in these infants.

NicuGal, MSN, RN · Jul 31, 2003

I don't know if I agree with the accept lower sats thing....it seems sure, we save the eyes, but these kids have desats and they accept the lower sats, what about their heads? We are seeing a lot more PVL it seems. We aren't allowed to turn the O2 up and down anymore as they are contributing the widely varying O2 with more damage to the eyes.

karenelizabeth · Aug 7, 2003

Our normal limits are 88-96% for babies born below 36 weeks ventilated and recieving O2, ventilated babies above that it's 92-96% babies post term on long term O2 it's 95-100% the exceptions are always cardiac babies. The limits should be documnted on the Kardex and prescribed by the doctor

I know exactly what you mean NicuGal about conserna about the lower limits but research really does seem to show that high oxygen increases cases of CLD and BPD. not sure if you have access to Cochrane Library but try this ref

Authors

Askie LM. Henderson-Smart DJ.

Title

Restricted versus liberal oxygen exposure for preventing morbidity and mortality in preterm or low birth weight infants.

Source

The Cochrane Library, (Oxford) ** (2):2003. (CD001077)

Abstract

A substantive amendment to this systematic review was last made on 16 July 2001. Cochrane reviews are regularly checked and updated if necessary.

Background: Whilst the use of supplemental oxygen has a long history in neonatal care, resulting in both significant health care benefits and harms, uncertainty remains as to the most appropriate range to target blood oxygen levels in preterm and low birth weight infants. Potential benefits of higher oxygen targeting include more stable sleep patterns and improved long term growth and development. However, there may be significant deleterious pulmonary effects and health service use implications resulting from such a policy.

Objectives: In preterm or low birth weight infants, does targeting ambient oxygen concentration to achieve a lower versus higher blood oxygen range, or administering restricted versus liberal supplemental oxygen, influence mortality, retinopathy of prematurity, lung function, growth or development?

Search strategy: The standard search strategy of the Neonatal Review Group was used. An additional literature search was conducted of the MEDLINE and CINAHL databases in order to locate any trials in addition to those provided by the Cochrane Controlled Trials Register (CENTRAL/CCTR).

Selection criteria: All trials in preterm or low birth weight infants utilising random or quasi-random patient allocation, in which ambient oxygen concentrations were targeted to achieve a lower versus higher blood oxygen range, or restricted versus liberal oxygen was administered, were eligible for inclusion.

Data collection and analysis: The methodological quality of the eligible trials was assessed independently by each author for the degree selection, performance, attrition and detection bias. Data were extracted and reviewed independently by the each author. Data analysis was conducted according to the standards of the Cochrane Neonatal Review Group.

Main results: The restriction of oxygen significantly reduced the incidence and severity of retinopathy of prematurity without unduly increasing death rates in the meta-analysis of the five trials included in this review. The one trial that specifically addressed the question of lower versus higher PaO2 found no effect on death, but did not report (in sufficient detail to warrant inclusion) the effect of this intervention on eye or other outcomes. The effects of either of these oxygen administration policies on other clinically meaningful outcomes including chronic lung disease and long term growth, neurodevelopment, lung or visual function were not reported in any of the available trials.

Reviewers' conclusions: The results of this systematic review confirm the commonly held view of today's clinicians that a policy of unrestricted, unmonitored oxygen therapy has potential harms, without clear benefits. However, the question of what is the optimal target range for maintaining blood oxygen levels in preterm/LBW infants was not answered by the data available for inclusion in this review.

NicuGal, MSN, RN · Aug 9, 2003

Thanks for the info :)