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J Pediatr. 2015 Sep;167(3):545-50.e1-2. doi: 10.1016/j.jpeds.2015.06.012. Epub 2015 Jul 2.

Automated versus Manual Oxygen Control with Different Saturation Targets and Modes of Respiratory Support in Preterm Infants.

Author information

1
Emma Children's Hospital AMC, Amsterdam, The Netherlands.
2
University Medical Center, Ulm, Germany.
3
The Medical Center of Postgraduate Education, Warsaw, Poland.
4
Silesian Institute Mother and Newborn, Chorzow, Poland.
5
James Cook University Hospital, Middlesbrough, United Kingdom.
6
Leiden University Medical Center, Leiden, The Netherlands.
7
Vittore Buzzi Children's Hospital, Milano, Italy.
8
University Hospital North Tees, Stockton, Cleveland, United Kingdom.
9
Alberta Children's Hospital, Calgary, Canada.
10
University of Miami, Miami, FL.
11
Czech Technical University in Prague, Prague, Czech Republic; Economedtrx, Lake Arrowhead, CA.

Abstract

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.

PMID:
26144575
DOI:
10.1016/j.jpeds.2015.06.012
[Indexed for MEDLINE]

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