RESUMEN
PURPOSE: To prospectively evaluate hazards in the process of supplemental oxygen therapy in very preterm infants hospitalized in a Dutch NICU. METHODS: A Failure Mode and Effects Analysis (FMEA) was conducted by a multidisciplinary team. This team identified, evaluated, and prioritized hazards of supplemental oxygen therapy in preterm infants. After accrediting "hazard scores" for each step in this process, recommendations were formulated for the main hazards. RESULTS: Performing the FMEA took seven meetings of 2 hours. The top 10 hazards could all be categorized into three main topics: incorrect adjustment of the fraction of inspired oxygen (FiO2), incorrect alarm limits for SpO2, and incorrect pulse-oximetry alarm limits on patient monitors for temporary use. The FMEA culminated in recommendations in both educational and technical directions. These included suggestions for (changes in) protocols on alarm limits and manual FiO2 adjustments, education of NICU staff on hazards of supplemental oxygen, and technical improvements in respiratory devices and patient monitors. CONCLUSIONS: The FMEA prioritized flaws in the process of supplemental oxygen therapy in very preterm infants. Thanks to the structured approach of the analysis by a multidisciplinary team, several recommendations were made. These recommendations are currently implemented in the study's center.
Asunto(s)
Presión de las Vías Aéreas Positiva Contínua/efectos adversos , Hiperoxia/prevención & control , Recien Nacido Extremadamente Prematuro/fisiología , Enfermería Neonatal/métodos , Oxígeno/efectos adversos , Lista de Verificación , Presión de las Vías Aéreas Positiva Contínua/métodos , Presión de las Vías Aéreas Positiva Contínua/enfermería , Femenino , Humanos , Hiperoxia/etiología , Recién Nacido , Masculino , Monitoreo Fisiológico/métodos , Países Bajos , Evaluación de Procesos y Resultados en Atención de Salud , Oxígeno/administración & dosificación , Estudios Prospectivos , Medición de Riesgo/métodos , Gestión de Riesgos/métodosRESUMEN
The electronic spectroscopy of cold protonated indole was investigated experimentally and theoretically. Two isomers were observed by experiment: The first isomer corresponds to the lowest-energy isomer in the calculations, absorbing at ~350 nm and protonated on the C3 atom of the pyrrole ring. According to our calculations, the absorptions of the other isomers protonated on carbon atoms (C2, C4, C5, C6, and C7) are in the visible region. Indeed, the absorption of the second observed isomer starts at 488 nm and was assigned to protonation on the C2 carbon of the pyrrole ring. Because good agreement was obtained between the calculated and experimental transitions for the observed isomers, reasonable ab initio transition energies can also be expected for the higher-energy isomers protonated on other carbon atoms, which should also absorb in the visible region. Protonation on the nitrogen atom leads to a transition that is blue-shifted with respect to that of the most stable isomer.
Asunto(s)
Indoles/química , Protones , Gases/química , Teoría Cuántica , Espectrofotometría UltravioletaRESUMEN
AIM: To quantify manual fraction of inspired oxygen (FiO(2)) adjustments performed by caregivers in extremely low birth weight (ELBW; ≤1000 g) infants, in relation to oxygen saturation (SpO(2)) and bedside care. METHODS: In a single-centre study, FiO(2) , SpO(2) and alarm limits of ELBW infants were collected for 3 days continuously, while caregivers were filmed. A descriptive analysis, focused on manual FiO(2) adjustments, was performed. RESULTS: Twelve ELWB infants were included. Total recording time was 726 h. FiO(2) was increased 851 times and decreased 1309 times; median (range) step size was 5% (1% to 65%) and -3% (-1% to -65%), respectively. Wide variation of FiO(2) adjustments for equal levels of SpO(2) was observed in all included infants. One hundred and twenty-six of 136 FiO(2) adjustments with a step size ≥15% and 111 of 171 desaturations <70% were associated with medical or nursing procedures. When FiO(2) was >21%, alarm limits for SpO(2) were set according to protocol (88-94%) in 64% of the time. Within these periods, SpO(2) was >94% for 30% and <88% for 16% of the time. CONCLUSIONS: Manual FiO(2) adjustments varied widely in frequency and step size. Deep desaturations and large FiO(2) adjustments were associated with medical or nursing procedures. When large adjustments are really necessary, it will be challenging to implement them in an automatic adjustment device.