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Automated versus manual control of inspired oxygen to target oxygen saturation in preterm infants: a systematic

Souvik Mitra1, Balpreet Singh2, Walid El-Naggar2

  • 1Division of Neonatal Perinatal Medicine, Department of Pediatrics, Dalhousie University & IWK Health Centre, Halifax, NS, Canada. souvik.mitra@iwk.nshealth.ca.

Journal of Perinatology : Official Journal of the California Perinatal Association
|January 4, 2018
PubMed

Insights

Automated fraction of inspired oxygen (FiO2) control improves oxygen saturation targeting in preterm infants. This method significantly increases time within target SpO2 ranges and reduces harmful hyperoxia and hypoxia events.

Area of Science:

  • Neonatal Medicine
  • Respiratory Physiology
  • Clinical Trial Methodology

Background:

  • Maintaining optimal oxygen saturation (SpO2) in preterm infants is critical for neurodevelopment and reducing mortality.
  • Manual control of fraction of inspired oxygen (FiO2) can lead to frequent fluctuations in SpO2, increasing risks of hyperoxia and hypoxia.
  • Automated FiO2 control systems aim to provide more stable and precise oxygenation.

Purpose of the Study:

  • To systematically review clinical trials comparing automated versus manual FiO2 control in preterm infants.
  • To evaluate the efficacy of automated FiO2 control in achieving target SpO2 levels.
  • To assess the impact of automated FiO2 control on reducing hyperoxic and hypoxic events.

Main Methods:

  • Systematic review of randomized controlled trials identified through comprehensive database searches (MEDLINE, Embase, CENTRAL, CINAHL).
  • Inclusion criteria focused on studies comparing automated FiO2 control with manual control in preterm infants receiving positive pressure respiratory support.
  • Primary outcome was the percentage of time spent within the target SpO2 range; meta-analysis used random-effects models.

Main Results:

  • Ten studies met inclusion criteria from 276 identified.
  • Automated FiO2 control significantly increased the time spent within the target SpO2 range by 12.8% (95% CI: 6.5-19.2%).
  • Automated control significantly reduced periods of hyperoxia (MD: -8.8%), severe hypoxia (SpO2 < 80%) (MD: -0.9%), and overall hypoxic events (MD: -5.6%).

Conclusions:

  • Automated FiO2 adjustment is superior to manual control for optimizing oxygenation in preterm infants.
  • This technology significantly improves time in target saturations, thereby reducing risks associated with abnormal oxygen levels.
  • Automated FiO2 control represents a valuable advancement in respiratory support for vulnerable preterm neonates.
Abstract

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