A randomised crossover trial of clinical algorithm for oxygen saturation targeting in preterm infants with frequent
Alexandra Clarke1, Emma Yeomans, Kristy Elsayed
1The Ritchie Centre, Monash Institute of Medical Research, Clayton, Vic., Australia.
Insights
Algorithm-based oxygen therapy did not improve oxygen saturation levels in preterm infants compared to routine nursing care. Further algorithm modifications are needed to enhance target range compliance for premature babies.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Care
- Clinical Trial Research
Background:
- Oxygen therapy in preterm infants aims to balance hyperoxia and hypoxia risks.
- Existing guidelines, like Vermont-Oxford's 'Breathsavers', inform current practices.
- Preterm infants often experience fluctuating oxygen saturation levels requiring careful management.
Purpose of the Study:
- To compare algorithm-based oxygen management with routine nursing care in preterm infants.
- To evaluate the proportion of time infants spent within the target SpO2 range.
- To assess compliance with SpO2 alarm limits under both care strategies.
Main Methods:
- A randomized crossover trial involving preterm infants (<32 weeks gestation) with frequent desaturations.
- Comparison of a 4-hour period of routine nursing care versus algorithm-based oxygen control.
- Data collected using Masimo oximeters and Babylog 8000+ ventilators via the Powerlab system.
Main Results:
- No significant difference in time spent within the SpO2 target range (34.6% vs. 38.3%, p=0.23).
- Similar compliance with SpO2 alarm limits between routine and algorithm-based care (58.4% vs. 64.7%, p=0.091).
- No differences observed in desaturation frequency, severity, or FiO2 adjustments.
Conclusions:
- Algorithm-based oxygen control did not improve SpO2 target range adherence in the studied unit.
- Current nursing care appears to be optimized, suggesting routine practices are effective.
- Significant algorithm modifications are likely required to improve oxygen saturation control in preterm infants.
Objectives:
Strategies for oxygen therapy for preterm infants, such as the Vermont-Oxford's 'Breathsavers' guidelines, seek to strike a balance between the potential risks of the extremes of hyperoxia and hypoxia in preterm infants. Using an algorithm based on those guidelines, we aimed to compare the proportion of time spent within the SpO2 target range during algorithm-based management of oxygen delivery compared with routine nursing care.
Study Design:
In a randomised crossover trial, maintenance of SpO2 over a 4-hour period during routine care was compared with algorithm-based control (administered by a dedicated research nurse). SpO2 target (88-92%) and alarm limits (86-94%) were identical in both arms. Infants <32 weeks' gestation were eligible if having >8 desaturations episodes to <85%/4 h while receiving continuous positive airway pressure/synchronised intermittent mandatory ventilation. Data was recorded via the Powerlab system from Masimo oximeters and Babylog 8000+ ventilators.
Results:
16 infants with a gestation of 26.7 ± 1.3 weeks (mean ± SD) and birth weight 901 ± 193 g were studied at a postmenstrual age of 30.5 ± 2.4 weeks. The percentage of time spent within target range was 34.6 ± 28.5% during routine care versus 38.3 ± 29.3% during algorithm-based care (p = 0.23). Compliance with alarm limits was 58.4 ± 21.8% during routine versus 64.7 ± 22.1% for algorithm-based care (p = 0.091). The frequency of desaturations, episode severity or number of FiO2 adjustments did not differ between the two care strategies.
Conclusions:
The observation that algorithm-based control did not improve time spent within the SpO2 target and alarm limits suggests nursing care has reached an optimum in the unit studied. Our finding indicates that significant modifications to the algorithm are likely to be necessary to improve target range compliance.
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