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Closed-loop oxygen system in late preterm/term, ventilated infants with different severities of respiratory disease
Ourania Kaltsogianni1, Theodore Dassios1,2, Christopher Harris2
1Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Insights
Closed-loop automated oxygen control (CLAC) improved oxygen saturation in ventilated infants, particularly those with severe respiratory distress. This automated system helps maintain target oxygen levels more effectively.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Care
- Medical Technology
Background:
- Maintaining optimal oxygen saturation is critical for ventilated preterm infants.
- Automated systems offer potential benefits over manual oxygen management.
- Infants with respiratory diseases require precise oxygenation support.
Purpose of the Study:
- To evaluate the efficacy of closed-loop automated oxygen control (CLAC) in ventilated infants.
- To assess CLAC performance across varying degrees of respiratory disease severity.
- To determine if CLAC is beneficial for infants with congenital diaphragmatic hernia (CDH).
Main Methods:
- A randomized crossover study design was used.
- Infants (>33 weeks gestation) were studied for 6 hours on two consecutive days.
- Participants received either standard care or standard care with CLAC (Oxygenie).
Main Results:
- CLAC significantly increased time in target oxygen range (92-96%) for infants requiring FiO2 ≥ 0.3 (61.6%) and those with CDH (34%).
- CLAC reduced time in hyperoxemia for infants with FiO2 ≥ 0.3 and shortened hyperoxemic episodes.
- In all infants, CLAC reduced the duration of desaturations (SpO2 < 92%).
Conclusions:
- Closed-loop automated oxygen control demonstrates significant benefits in improving oxygenation control for ventilated infants.
- CLAC may be particularly advantageous for neonates experiencing more severe respiratory distress.
- The system shows promise in managing oxygenation in complex cases like CDH.
Aim:
To evaluate closed-loop automated oxygen control (CLAC) in ventilated infants >33 weeks of gestation with different respiratory disease severities.
Methods:
Infants were studied on two consecutive days for 6 h each day. They were randomised to receive standard care or standard care with CLAC (Oxygenie) first. Analyses were performed of the results of infants with or without an FiO2 ≥ 0.3 and infants with congenital diaphragmatic hernia (CDH).
Results:
Thirty-one infants with a median (IQR) gestational age of 37.9 (37.1-38.9) weeks were studied at a median postmenstrual age (IQR) of 38.9 (37.4-39.8) weeks. In infants with an FiO2 ≥ 0.3 (n = 8), CLAC increased the time spent in target oxygen range (92-96%) by 61.6% (p = 0.018), whereas in infants with an FiO2 < 0.3, the time in target was increased by 3.8% (p = 0.019). During CLAC, only infants with an FiO2 ≥ 0.3 spent less time in hyperoxemia (SpO2 > 96%) (p = 0.012) and hyperoxemic episodes were shorter (p = 0.012). In both groups, CLAC reduced the duration of desaturations (SpO2 < 92%, p < 0.001). In CDH infants, CLAC increased the time spent in target oxygen range by 34% (p = 0.036) and the median duration of desaturations was reduced (p = 0.028).
Conclusion:
CLAC may be more useful in infants with more severe respiratory distress.
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