40% oxygen: Is it better or worse?

[Carlos Delgado]

Background: Neonatal resuscitation and positive pressure ventilation.

Decision node: Oxygen concentration: 21%... 40% ... 100%

Question: which one is better, under what circumstances?

Carlos DELGADO

Pediatrician Neonatologist

Instituto Nacional de Salud del Niño

Lima PERU

[Stefan Johansson]

There's a revision in pipeline, of the Swedish guidelines on resuscitation. There were quite a lot of discussion regarding the evidence of using O2 immediately after birth, at the workshop discussing this revision.

The data from Saugstads group in Norway and others would suggest that room air would be fine, but practises vary a lot. I'd reckon our new (Swedish) guidelines will be suggesting less/no extra oxygen from the start of the resuscitation, but vaguely suggest that oxygen may me added/increased later during the resuscitation.

Now, while awaiting the new guidelines we use 40% in our unit.

PS. I added a poll to this discussion. DS.

[Guest]

Do the swedish guidlines differ from the ILCOR guidance?

[Stefan Johansson]

Do the swedish guidlines differ from the ILCOR guidance?

Well, I don't think the new guidelines will differ at any major points. The conclusion of the workshop last year was that the (Swedish) working group needed to await the ILCOR report.

[Guest]

The new guidlines do not offer any clear guidance re: use of oxygen. The latest version of the UK guidelines will state that there is no clear evidence for which oxygen concentration to use- so it is a personal choice where to start but increase fio2 if no improvement. Sounds like they are sitting on the fence on that one.

Andrew Kapetanakis

University Hospital London

[Stefan Johansson]

Dear Andrew, you're absolutely right that the latest ILCOR document gives no strict guidelines regarding O2 during resuscitation, although ILCOR explicitely say that room air could be used at the initiation of resuscitation (see quoted section below).

I'd guess the new upcoming Swedish guidelines will contain similar statements as to the British recommendation you refer to, ie joining at the same fence!

*******

From the ILCOR report:

"Although the standard approach to resuscitation is to use 100% oxygen, it is reasonable to begin resuscitation with an oxygen concentration of less than 100% or to start with no supplementary oxygen (ie, start with room air). If the clinician begins resuscitation with room air, it is recommended that supplementary oxygen be available to use if there is no appreciable improvement within 90 seconds after birth. In situations where supplementary oxygen is not readily available, positive-pressure ventilation should be administered with room air."

[Audrius]

Dear Andrew,

Would you be so kind to explain a little bit wider your phrase "it is a personal choice where to start but increase fio2 if no improvement''. I liked it very much, but I am not sure of the same meaning with your vision and mine. Thank you. Comments of other colleagues are also welcome.

Audrius

Kaunas Medical University Hospital,

Lithuania

[Guest sudeep]

we do the same 21%

[sjoher]

I usually start my resuscitation with 50% and if baby doesnot response to it than increase to 100%.

[livia_sibiu@yahoo.com]

start with 21%, add oxygen if no response in 60 -90 sec

Livia Ognean, Sibiu, Romania