Ventilator Management Practices Are Dependent Upon Time Of Day 1560

Recent evidence supporting the relationship between hypocapnia and poor neurodevelopmental outcome as well as the desire to limit pulmonary barotrauma has raised questions regarding optimal pCO₂levels in neonates with respiratory distress syndrome (RDS). The purpose of this study was to examine the relationship between ventilator management practices and pCO₂ levels. Methods: A retrospective chart review of the last 45 patients admitted for RDS was performed. All blood gas results (n=909) and resulting ventilator changes in the first 3 days of life were recorded. Any increase in pressure or IMV was considered as an increase in ventilator support. pCO₂ values (mmHg) are grouped by the practitioner's response to ventilator management. Blood gas results were divided by shift and compared by one-way ANOVA (shift 1=0800-1600, shift 2+1600-2400 and shift 3=2400-0800). Results: The mean BW and GA was 846.3±244g and 26.6±1.9wks. The mean pCO₂ value which resulted in an increase in ventilator support was significantly higher during shift 1 compared to shift 2 (p<0.05) but not different from shift 3. There were no differences in mean pCO₂values resulting in a decrease in ventilator support. pCO₂ values resulting in no change in ventilator support were higher during shift 2 compared to shift 3, p<0.05. Table

Table 1

Conclusion: This study demonstrates the variation in ventilator management during various times of day. In addition, these data suggest a tolerance of higher pCO₂ values during the day shift than during evenings. We speculate that practitioners are more comfortable with higher pCO₂ values during shift 1 and act to increase ventilator settings at a lower pCO₂ during shift 2 in order to avoid respiratory decompensation during the night.