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G189(P) Using the incidence of hypocarbia as a quality measure of ventilator management
  1. L Wajid,
  2. C Morgan
  1. Neonatology, Liverpool Women’s Hospital, Liverpool, UK

Abstract

Background Hypocarbia has been associated with adverse neurodevelopmental outcome. Hypocarbia during mechanical ventilation indicates overventilation and is therefore a quality marker of ventilator management. In previous audits of hypocarbia incidence we have previously shown that tidal volume measurement and experience of neonatal trainees affects the incidence of hypocarbia in ventilated preterm infants in the first week of life. We have subsequently changed our ventilation policy and induction programme.

Aims This re-audit compares the incidence of significant hypocarbia (< 4kPa) in ventilated infants < 1500g, <32 weeks gestation with respect to:

  • Trainee experience.

  • Individual management of hypocarbia episodes using time taken to achieve normocarbia.

Methods A retrospective data analysis of blood gases were obtained from electronic patient data management system for all eligible patients from August 2012 to August 2014 (Audit 3). The percentage of BG (blood gas) with hypocarbia was calculated for days 1–7. Monthly percentages were calculated for new trainees (months 1–2) and the rest of the training period (months 3–6). Response times to hypocarbia were calculated in a subset of ventilated infants from Jan–Aug 2014.

Results The monthly incidence of hypocarbia is compared for all 3 audits in Table 1. There is no significant difference between hypocarbia incidence in audit 3 and audit 2 but trainee experience now has no effect. In the subset (n = 60) the median time interval until the next BG sample was 60 min (IQR 40–90 min). Median time to correct hypocarbia was 83 min (IQR 50–120 min). Both statistically significantly lower (p < 0.05) than audit 1.

Abstract G189(P) Table 1

Hypocarbia rates with median (range)monthlypercentages

Conclusion

  • The most recent hypocarbia rates are independent of paediatric trainee experience

  • There has been a significant reduction in time taken to correct hypocarbia.

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