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Automated versus Manual Oxygen Control with Different Saturation Targets and Modes of Respiratory Support in Preterm
Anton H van Kaam1, Helmut D Hummler2, Maria Wilinska3
1Emma Children's Hospital AMC, Amsterdam, The Netherlands.
Insights
Automated fraction of inspired oxygen (FiO2) control improved arterial oxygen saturation (SpO2) targeting in preterm infants. This method reduced hypoxemia and required fewer manual adjustments compared to manual control.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Respiratory Physiology
Background:
- Maintaining optimal arterial oxygen saturation (SpO2) is critical for preterm infants.
- Current methods for oxygen management can be challenging, potentially leading to hypoxemia or hyperoxemia.
Purpose of the Study:
- To evaluate the efficacy and safety of automated FiO2 adjustment (A-FiO2) in preterm infants.
- To compare A-FiO2 with manual FiO2 (M-FiO2) control in maintaining target SpO2 ranges (higher: 91%-95%, lower: 89%-93%).
Main Methods:
- Eighty preterm infants on respiratory support were randomized to SpO2 target ranges.
- Infants received both A-FiO2 and M-FiO2 for 24 hours each in a randomized sequence.
- Data collected included percent time within target SpO2, hypoxemia, and hyperoxemia events.
Main Results:
- A-FiO2 control resulted in a higher percentage of time within the target SpO2 range compared to M-FiO2.
- A-FiO2 significantly reduced time spent in hypoxemia (SpO2 <80%) across both target ranges.
- Manual adjustments were significantly reduced with A-FiO2 control.
Conclusions:
- Automated FiO2 control is effective in improving SpO2 targeting in preterm infants.
- A-FiO2 enhances safety by reducing hypoxemia and the need for manual interventions.
- The benefits of A-FiO2 were observed in both noninvasive and invasive respiratory support settings.
Objective:
To determine the efficacy and safety of automated adjustment of the fraction of inspired oxygen (FiO2) in maintaining arterial oxygen saturation (SpO2) within a higher (91%-95%) and a lower (89%-93%) target range in preterm infants.
Study Design:
Eighty preterm infants (gestational age [median]: 26 weeks, age [median] 18 days) on noninvasive (n = 50) and invasive (n = 30) respiratory support with supplemental oxygen, were first randomized to one of the SpO2 target ranges and then treated with automated FiO2 (A-FiO2) and manual FiO2 (M-FiO2) oxygen control for 24 hours each, in random sequence.
Results:
The percent time within the target range was higher during A-FiO2 compared with M-FiO2 control. This effect was more pronounced in the lower SpO2 target range (62 ± 17% vs 54 ± 16%, P < .001) than in the higher SpO2 target range (62 ± 17% vs 58 ± 15%, P < .001). The percent time spent below the target or in hypoxemia (SpO2 <80%) was consistently reduced during A-FiO2, independent of the target range. The time spent above the target range or at extreme hyperoxemia (SpO2 >98%) was only reduced during A-FiO2 when targeting the lower SpO2 range (89%-93%). These outcomes did not differ between infants on noninvasive and invasive respiratory support. Manual adjustments were significantly reduced during A-FiO2 control.
Conclusions:
A-FiO2 control improved SpO2 targeting across different SpO2 ranges and reduced hypoxemia in preterm infants on noninvasive and invasive respiratory support.
Trial Registration:
ISRCTN 56626482.
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