Clinical quantification of SpO2 instability using a new histogram classification system: a clinical study

Borenstein-Levin, Liron; Konikoff, Laura; Solimano, Alfonso

doi:10.1038/s41390-019-0566-6

Cited by 12 publications

(6 citation statements)

References 13 publications

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“…Infants with progressively unstable histograms required more respiratory support at term corrected gestation and needed prolonged ventilator support compared with infants achieving higher oxygen saturations with stable oxygenation patterns. 16 These histogram subtypes cannot be applied to infants in the present study as many infants were on 21% FiO 2 prior to weaning from CPAP. We have also previously reported that systematically monitoring oxygen saturation histogram patterns in preterm infants may reduce death or severe retinopathy of prematurity.…”

Section: Discussionmentioning

confidence: 92%

Oxygen saturation histograms predict nasal continuous positive airway pressure-weaning success in preterm infants

2020

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BACKGROUND: Continuous positive airway pressure (CPAP) is widely used in preterm infants. Identification of readiness for weaning from CPAP can balance benefits with risks of CPAP exposure. We tested the hypothesis that preterm infants that successfully transition off CPAP have higher oxygen saturations prior to weaning compared with infants who fail weaning from CPAP. METHODS: This was a single-center-matched case-control study in infants ≤30 weeks' gestation receiving ≤30% FiO 2 weaned off CPAP during the first postnatal week. Cases were infants placed back on CPAP within 7 days of being taken off CPAP, whereas control infants remained off CPAP for 7 consecutive days following CPAP discontinuation. Infants were matched on gestational age at birth (±10 days). Prospectively collected histograms detailing the distribution of oxygen saturations prior to CPAP discontinuation were compared between cases and controls. RESULTS: Over a 12-month monitoring period, 36 infants met inclusion criteria. Baseline characteristics, morbidities, and clinical variables did not differ between cases and controls. Controls achieved oxygen saturations of 95-97 and 97-100% for longer duration compared to cases (p < 0.05). CONCLUSIONS: In preterm infants with RDS receiving CPAP and ≤30% FiO 2 , infants with higher oxygen saturations had greater success in transitioning off CPAP.

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Section: Discussionmentioning

confidence: 92%

Oxygen saturation histograms predict nasal continuous positive airway pressure-weaning success in preterm infants

2020

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“…A learning curve is also expected over time. Reference values based on historical data from a comparable population and more objective scores, for example a histogram classification score [ 25 , 26 ], could support data interpretation. SpO 2 histograms were included in our prototype as these are not presented by the standard bedside monitoring software of the unit, in contrast to some other centers.…”

Section: Discussionmentioning

confidence: 99%

Development of a Web-Based Oxygenation Dashboard for Preterm Neonates: A Quality Improvement Initiative

Poppe,

Smorenburg,

Goos

et al. 2024

J Med Syst

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Background: Preterm neonates are extensively monitored to require strict oxygen target attainment for optimal outcomes. In daily practice, detailed oxygenation data are hardly used and crucial patterns may be missed due to the snapshot presentations and subjective observations. This study aimed to develop a web-based dashboard with both detailed and summarized oxygenation data in real-time and to test its feasibility to support clinical decision making. Methods: Data from pulse oximeters and ventilators were synchronized and stored to enable real-time and retrospective trend visualizations in a web-based viewer. The dashboard was designed based on interviews with clinicians. A preliminary version was evaluated during daily clinical rounds. The routine evaluation of the respiratory condition of neonates (gestational age < 32 weeks) with respiratory support at the NICU was compared to an assessment with the assistance of the dashboard. Results: The web-based dashboard included data on the oxygen saturation (SpO2), fraction of inspired oxygen (FiO2), SpO2/FiO2 ratio, and area < 80% and > 95% SpO2 curve during time intervals that could be varied. The distribution of SpO2 values was visualized as histograms. In 65% of the patient evaluations (n = 86) the level of hypoxia was assessed differently with the use of the dashboard. In 75% of the patients the dashboard was judged to provide added value for the clinicians in supporting clinical decisions. Conclusions: A web-based customized oxygenation dashboard for preterm neonates at the NICU was developed and found feasible during evaluation. More clear and objective information was found supportive for clinicians during the daily rounds in tailoring treatment strategies.

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“…In agreement with our results, a reduced V A /Q in adults leads to SpO 2 instability breathing room air. By adding a time dimension, the different effects of V A /Q or shunt in individual adult patients breathing air is more clearly illustrated by dynamic waterfall plots of continuously monitored SpO 2 ( Entwistle et al, 1991 ; Jones and Jones, 2000 ; Jones, 2021 ) than do “static” histograms ( Borenstein-Levin et al, 2020 ). A typical example of unstable SpO2 in a patient with reduced V A /Q breathing air is shown in Figure 3 in Ref ( Jones, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Unstable SpO2 in preterm infants: The key role of reduced ventilation to perfusion ratio

Stoecklin

Choi²,

Dassios³

et al. 2023

Front. Physiol.

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Introduction: Instability of peripheral oxyhemoglobin saturation (SpO2) in preterm infants is correlated with late disability and is poorly understood. We hypothesised that a reduced ventilation to perfusion ratio (VA/Q) is the key predisposing factor for SpO2 instability.Methods: We first used a mathematical model to compare the effects of reduced VA/Q or shunt on SaO2 stability (SaO2 and SpO2 are used for model and clinical studies respectively). Stability was inferred from the slope of the SaO2 vs. inspired oxygen pressure (PIO2) curve as it intersects the 21 kPa PIO2 line (breathing air). Then, in a tertiary neonatal intensive care unit, paired hourly readings of SpO2 and PIO2 were recorded over a 24 h period in week old extremely preterm infants. We noted SpO2 variability and used an algorithm to derive VA/Q and shunt from the paired SpO2 and PIO2 measurements.Results: Our model predicted that when VA/Q < 0.4, a 1% change in PIO2 results in >8% fluctuation in SaO2 at 21 kPa PIO2. In contrast, when a 20% intrapulmonary shunt was included in the model, a 1% change in PIO2 results in <1% fluctuation in the SaO2. Moreover, further reducing the VA/Q from 0.4 to 0.3 at 21 kPa PIO2 resulted in a 24% fall in SaO2. All 31 preterm infants [mean gestation (±standard deviation) 26.2 (±1) week] had VA/Q < 0.74 (normal >0.85) but only two infants had increased shunt at 1.1 (±0.5) weeks’ postnatal age. Median (IQR) SpO2 fluctuation was 8 (7)%. The greatest SpO2 fluctuations were seen in infants with VA/Q < 0.52 (n = 10): SpO2 fluctuations ranged from 11%–17% at a constant PIO2 when VA/Q < 0.52. Two infants had reduced VA/Q and increased shunt (21% and 27%) which resolved into low VA/Q after 3–6 h.Discussion: Routine monitoring of PIO2 and SpO2 can be used to derive a hitherto elusive measure of VA/Q. Predisposition to SpO2 instability results from reduced VA/Q rather than increased intrapulmonary shunt in preterm infants with cardiorespiratory disease. SpO2 instability can be prevented by a small increase in PIO2.

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Clinical quantification of SpO2 instability using a new histogram classification system: a clinical study

Cited by 12 publications

References 13 publications

Oxygen saturation histograms predict nasal continuous positive airway pressure-weaning success in preterm infants

Oxygen saturation histograms predict nasal continuous positive airway pressure-weaning success in preterm infants

Development of a Web-Based Oxygenation Dashboard for Preterm Neonates: A Quality Improvement Initiative

Unstable SpO2 in preterm infants: The key role of reduced ventilation to perfusion ratio

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