PURPOSE: Hypoxia in premature infant is a pathologic state. Intervention is usually warranted. There hasn't been a simple way of monitoring staff compliance in keeping SpO2 within a set range. Certain pulse oximeters have a histogram function that monitors the percentage of time an infant spends in different SpO2 ranges. This histogram can be accessed inconspicuously at any time. The goal of the study was to describe an alternative method of monitoring oxygenation compliance in a tertiary care NICU in hopes of avoiding prolonged exposure to hypoxia.
METHODS: Infants who were <1500grams and requiring supplemental oxygen were observed. Saturations were to be kept at SpO2 88-95% (Masimo SET V5) by unit protocol. Without notifying the clinical staff, the histogram was manually recorded daily. Twenty-four hour epochs were analyzed. Attempts were made to record at least 7 epochs per infant. If an infant was weaned to room air (FiO2 0.21), then it was noted how long an infant spent off of supplemental oxygen.
RESULTS: 100 epochs were analyzed. The average percentage of time with SpO2 <80% was 4.21% (±4.51%), and the average percentage of time an infant spent with SpO2 between 81-85% was 6.79% (±5.22%). The cumulative average percentage of time with SpO2 <85% was 11% (±9.2%). The highest percentage of time with SpO2 <80% and between 81-85% was 26% and 29% respectively.
CONCLUSION: Evaluating the pulse oximeter's histogram is an alternative way to assess staff compliance to a stated oxygenation protocol.
CLINICAL IMPLICATIONS: In most NICU, hypoxia is monitored by a pulse oximeter, and SpO2 values are recorded by staff at set intervals. This may not reflect an accurate picture of an infants oxygen state. The pulse oximeter's histogram may be a valuable tool in helping to prevent prolonged periods of hypoxia. It can also be used to monitor staff accuracy in charting. By hiding the histogram, staff compliance can be assessed without the bias of known study participation. Care patterns can be more accurately evaluated; and improvement strategies, instituted.
DISCLOSURE: Daniel Saesim, None.