Closed-loop automated oxygen control in late preterm and term, ventilated infants: A randomised controlled trial

Area of Science:

• Neonatalogy
• Pediatric Critical Care
• Respiratory Medicine

Background:

• Maintaining optimal oxygen saturation is crucial for ventilated infants.
• Manual oxygen control can lead to significant periods of hyperoxia and hypoxia.
• Automated systems aim to improve oxygenation stability in vulnerable infants.

Purpose of the Study:

• To compare closed-loop automated oxygen control (CLAC) with manual oxygen control in ventilated preterm and term infants.
• To assess the impact of CLAC on time spent above, within, and below the target oxygen saturation range.
• To evaluate the duration of supplemental oxygen and frequency of manual adjustments.

Main Methods:

• Randomized controlled trial involving late preterm and term infants requiring mechanical ventilation.
• Infants were assigned to either CLAC or manual oxygen control from recruitment until extubation.
• Oxygen saturation (SpO2) and inspired oxygen concentration (FiO2) were continuously monitored.

Main Results:

• CLAC significantly reduced time spent above the target SpO2 range (>96%) by 20% (p<0.001).
• CLAC increased time spent within the target SpO2 range (92%-96%) by 32% (p<0.001) and reduced hyperoxia (p=0.003).
• CLAC decreased time in hypoxemia (<85%) (p=0.017) and significantly reduced manual FiO2 adjustments (p<0.001).

Conclusions:

• CLAC is associated with improved oxygenation control in ventilated near-term infants.
• The system reduces hyperoxemia and increases time within the desired oxygen saturation range.
• CLAC simplifies oxygen management by decreasing the need for manual FiO2 adjustments.