Effects of a new device for automated closed loop control of inspired oxygen concentration on fluctuations of arterial and different regional organ tissue oxygen saturations in preterm infants

Gajdos, Marek; Waitz, Markus; Mendler, Marc Robin; Braun, Wolfgang; Hummler, Helmut

doi:10.1136/archdischild-2018-314769

Cited by 27 publications

(29 citation statements)

References 17 publications

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“…Recent targeting of higher saturations is associated with an increase in need for treatment for ROP [86], and in Sweden the effect of increased risk of ROP has negated the sensitivity of poor postnatal growth for prediction of ROP [87]. Servo-controlled oxygen algorithms are now sufficiently developed to maintain saturations within targeted range more of the time both with ventilated infants and those receiving non-invasive respiratory support, although no studies have been sufficiently powered to determine if there are any beneficial effects on outcome [88, 89]. …”

Section: Oxygen Supplementation Beyond Stabilisationmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of “European Guidelines for the Management of RDS” by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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Section: Oxygen Supplementation Beyond Stabilisationmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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“…Sixteen single or multicentre clinical studies have been undertaken comparing closed loop automated oxygen control to manual oxygen control in neonates to determine whether automating FiO 2 control was associated with a greater target SpO 2 achievement. They consistently demonstrated that closed loop automated oxygen control maintained the patient within their target SpO 2 range a significantly greater proportion of the time than manual control . Closed loop automated oxygen control has been demonstrated to reduce hyperoxic episodes, in one study almost halving the frequency (9.3 to 4.7 episodes per 90 minutes) and the duration (19.3 s‐10.1 s) of hyperoxic episodes and in another study reducing the median percentage time spent with an SpO 2 > 95% from 41.9% to 19.3% ( P < .001) .…”

Section: Resultsmentioning

confidence: 94%

“…Multiple studies have found that automated oxygen control systems lead to a decrease in the number of manual interventions made by staff . Studies have reported that clinical staff needed to adjust the FiO 2 less than once per hour when there was automated control, compared with as many as 29 times per hour during manual control . A randomised study of one automated FiO 2 system found that the automated system made 7540 FiO 2 adjustments in a 12‐hour period, whereas staff made 80 adjustments over the same time period in the manual control group .…”

Section: Resultsmentioning

confidence: 99%

Closed loop automated oxygen control in neonates—A review

et al. 2019

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Abbreviations: CLAC, Closed loop automatic control; CPAP, Continuous positive airway pressure; FiO 2 , Fractional concentration of inspired oxygen; MD, Mean difference; NCPAP, Nasal continuous positive airway pressure; PaO 2 , Partial pressure of oxygen in arterial blood; PID, Proportional integral differential; RDS, Respiratory distress syndrome; ROS, Reactive oxide species; SpO 2 , Oxygen saturation measured by pulse oximetry.Abstract Aim: Neonates frequently require supplementary oxygen but may develop complications if the oxygen saturation is outside the target range. This review aimed to determine whether the algorithms used in closed loop automated oxygen control systems influenced their efficacy and whether use of the systems reduced relevant, long-term neonatal complications. Methods: A literature search was conducted using PubMed and Google Scholar. The search terms were 'closed loop' or 'automat*', 'oxygen' and 'neonat*'.Results: Eighteen studies were identified: sixteen comparison clinical studies, an observational study and an animal study. Overall, closed loop automated oxygen control was associated with an increased percentage of time spent within the target oxygen saturation range and there were fewer manual adjustments to the inspired oxygen concentration when compared with manual oxygen control. The systems were effective in infants on non-invasive respiratory support or mechanically ventilated, but no study included term-born infants. No long-term data were available to determine if complications of oxygen toxicity were reduced. Conclusion:Closed loop automated oxygen control has been shown in short term trials including preterm and low birth weight infants to improve target saturation achievement. Whether long-term outcomes will be improved with their use requires investigation. K E Y W O R D Sbronchopulmonary dysplasia, closed loop automated oxygen control, neonate, retinopathy of prematurity

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“…To evaluate their system, they compared the time spent at the oxygenation target using the controller to a clinician-in-the-loop system. This metric was also used by others [38][39][40][41][42][43][44] and the automated system was as good or better than the manual procedure in all cases.…”

Section: Control Based On Gas Exchangementioning

confidence: 95%

“…A recent review of oxygenation control was published by Claure and Bancalari in 2013 [46]. The systems presented by Claure et al [41], Urschitz et al [42], and Gajdos et al [44] have been developed further and are now commercially available as AVEA-CLiO2 (CareFusion, Yorba Linda, CA, USA), CLAC (Löwenstein Medical GmbH & Co. KG, Bad Ems, Germany), and SPOC (Fritz Stephan GmbH, Gackenbach, Germany), respectively. Setpoint control is the dynamic response of the system to changes of the target.…”

Section: Control Based On Gas Exchangementioning

confidence: 99%

The dawn of physiological closed-loop ventilation—a review

et al. 2020

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The level of automation in mechanical ventilation has been steadily increasing over the last few decades. There has recently been renewed interest in physiological closed-loop control of ventilation. The development of these systems has followed a similar path to that of manual clinical ventilation, starting with ensuring optimal gas exchange and shifting to the prevention of ventilator-induced lung injury. Systems currently aim to encompass both aspects, and early commercial systems are appearing. These developments remain unknown to many clinicians and, hence, limit their adoption into the clinical environment. This review shows the evolution of the physiological closed-loop control of mechanical ventilation.

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Effects of a new device for automated closed loop control of inspired oxygen concentration on fluctuations of arterial and different regional organ tissue oxygen saturations in preterm infants

Abstract: Closed-loop FiO using SPOC significantly increased time of arterial SpO within the intended range in VLBWI and decreased the need for manual adjustments when compared with the routine adjustment by staff members. StO was not significantly affected by the mode of oxygen control.

Cited by 27 publications

References 17 publications

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

Closed loop automated oxygen control in neonates—A review

The dawn of physiological closed-loop ventilation—a review

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