Recent discussions
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ILCOR Staff
Thank you. Your point is well made and really needs to be addressed by: 1. Evidence that of slow increase perhaps from video assessments which are more common now. 2. Regional guidelines to address this pragmatic problem. Whilst your approach is understandable there is no evidence to support it at resent and this PICOST was only addressing initial oxygen concentration. As some others have suggested, when more evidence is available, we need to address issues such as increasing and weaning oxygen concentrations. -
ILCOR Staff
This recommendation does not prevent that approach as it was not addressed by the PICOST. However, there is no evidence in terms of the outcomes assessed to either support or refute the approach you suggest. It is interesting that in the RESAIR studies as many babies were switched to air from 100% oxygen as the reverse. However, those studies were not performed in the era of widespread saturation assessment. It may be that more data will become available on HR response with the wider use of ECG. -
ILCOR Staff
Thank you as in my comments above: this recommendation does not rule out increasing the concentration of oxygen as it refers to the starting concentration. Your suggestion of starting at 30-40% in secondary apnoea and subsequent increases is interesting but there is no evidence to support or refute such an approach. We are therefore not able to comment upon this in our recommendation. -
ILCOR Staff
Thank you. Unfortunately the PICOST only addressed the initial oxygen concentration at which to commence resuscitation. In 2015 the timing of any increase in concentration was addressed and there was no human and conflicting animal data. It was a consensus agreement that it was reasonable to increase the concentration of oxygen if the heart rate did not respond to adequate ventilation and should be increased if compressions were commenced if it had not occurred before. More evidence is of course required -
ILCOR Staff
Thank you -
ILCOR Staff
We agree absolutely that ensuring adequate ventilation is essential although this PICOST and the studies included did not specifically address and report on the adequacy of ventilation. -
ILCOR Staff
Thank you for your comments. Your assertions about the brain requirements for oxygen are interesting but not born out by pragmatic randomised controlled trials comparing 21% vs 100%. The recommendation does not advocate maintaining hypoxic for 10 minutes in any circumstance. In fact it is a recommendation for concentration at which to commence resuscitation. ILCOR and the neonatal group exist to examine evidence for practice in terms of resuscitation. Certainly more evidence is required to hone recommendations and improve care but we must guard against implementing change based upon mere unproven opinion be it medical or legal. In the past that approach has led to serious harm in neonatology. This PICOST addressed the evidence for the initial oxygen concentration at which to commence resuscitation of the newborn. -
ILCOR Staff
Thank you -
ILCOR Staff
You may want to do this but whilst there may be theoretical advantages to such an approach we need to be aware that they are unproven. Therefore for this international CoSTR we could not recommend such an approach in the absence of evidence to support it. Guideline authors, or institutions may choose to alter approaches for specific groups. If they do it would be helpful to publish results. -
ILCOR Staff
Thank you. This was not the focus of the PICOST and there is insufficient data to define this. It will in fact vary according to the current clinical practice and level of resources available. If BVM is used in a low resource setting the cost of 21% is zero. However, if T-piece is used and piped air is required the cost may be significant. It will need institutions or health economies to look at this locally.