Effect of Conventional High Flow Oxygen Therapy Compared to Conservative Oxygen Therapy in Mechanically Ventilated Neonates

Abstract

Background: Mechanically ventilated neonates are usually exposed to high oxygen therapy and due to common clinical practice and lack of knowledge about the target and optimum dose & duration of oxygen administration hyperoxia occurs frequently. The study was done to compare the effect between conventional high flow and conservative oxygen therapy.

Materials & Methods: A prospective study was done in Dhaka Shishu Hospital NICU from July 2013 to June 2014 and enrolled those were underwent invasive mechanical ventilation. Ventilator settings, FiO₂ and SpO₂ were recorded for the first 48 hours. The comparison of conventional high FiO₂ (> 0.7-1.0) and conservative FiO₂(< 0.7) therapy was assessed by SpO₂, PaO₂, PaO₂/ FiO₂ ratio and lung injury score within 48 hours of exposure and was analyzed.

Results: Among total 40 cases 30/40(75%) were exposed to conventional high FiO₂. After invasive mechanical ventilation, there was improvement of SpO₂ in both group (76.7% vs 70%) but there was no significant difference in between conventional high FiO₂ implementation and conservative group(P=0.67). PaO₂/ FiO₂ ratio also improved after ventilation (145.17 vs 328.40, P=0.013) in both groups but indicate lung injury in conventional high FiO₂ group. After invasive mechanical ventilation 53% (16/30) patients were suffering from acute lung injury(ALI) & acute respiratory distress syndrome (ARDS) with high exposure of FiO₂ (>0.7-1) and only 40% (4/10) patient developed ALI & ARDS in low exposure group (FiO₂<0.7).

Conclusions: Conventional high FiO₂ or liberal O₂ therapy in mechanically ventilated neonates improves SpO₂ but conventional high FiO₂ may causes iatrogenic lung injury.

BANGLADESH J CHILD HEALTH 2021; VOL 45 (1) : 19-24