Stress Oximetry: Description of a Test to Determine Readiness for Discontinuing Oxygen Therapy in Infants with Chronic Lung Disease

Abstract

Background In infants with CLD there are no objective tests to monitor an infant's progress towards weaning out of oxygen inhalation therapy (O2IT). A test involving staged maneuvers of increasing respiratory stress while decreasing oxygen support, termed Stress Oximetry (StressOx), has been used at our center for weaning O2IT. Objective To report the clinical utility of “StressOx” in evaluating readiness for discontinuing O2IT in infants with CLD. Methods A retrospective review was done of StressOx tests administered at our center from 2002-2008. StressOx was performed based on a consistent clinical protocol in all eligible infants on O2IT. O2IT was generally discontinued after infant had passed two StressOx tests and subsequently infants were monitored for a minimum of 7 days to determine successful weaning. Results There were 279 infants with 899 tests that met inclusion criteria. An average of 3 tests per infant was done, one week apart. The test had a specificity of 97.4% and a positive predictive value of 99.6% in determining success of discontinuing O2IT. Conclusions StressOx appears to be a clinically useful test that may help in determining an infant's ability to successfully wean out of O2IT. Further validation of this test is warranted.

Anemia, nutrition, and ambulatory oxygen weaning in a cohort of oxygen‐dependent premature infants

“…The authors report that the test has a specificity of 97.4% and a predictive positive value of 99.6% in determining oxygen weaning success. 24 We prefer staggered weaning to reduce stress and safety issues caused by total oxygen suspension. Various guidelines from the United States, England, and Australia have been published on ambulatory management of OD preterm infants and how to reach lowrisk weaning in these past 10 years, [25][26][27] all of them are in agreement with our guidelines implemented since 1999.…”

“…There are other oxygen weaning techniques reported, such as that described by Hussain et al in Connecticut, USA, where stress oximetry is performed while monitoring heart rate and dynamic oximetry with a total suspension of supplemental oxygen. The authors report that the test has a specificity of 97.4% and a predictive positive value of 99.6% in determining oxygen weaning success 24 . We prefer staggered weaning to reduce stress and safety issues caused by total oxygen suspension.…”

Anemia, nutrition and ambulatory oxygen weaning in a cohort of oxygen-dependent premature infants.

“…There are other oxygen weaning techniques reported, such as that described by Hussain et al in Connecticut, USA, where stress oximetry is performed while monitoring heart rate and dynamic oximetry with total suspension of supplemental oxygen. The authors report that the test has a specificity of 97.4% and a predictive positive value of 99.6% in determining oxygen weaning success 24 . We prefer a staggered weaning, to reduce stress and safety issues caused by total oxygen suspension.…”