Quicker response results in better SpO2 control – a comparison of 3 FiO2-titration strategies in ventilated preterm infants

Abstract

Quicker response results in better SpO2 control -a comparison of 3 FiO2-titration strategies in ventilated preterm infants. Ann Agric Environ Med. 2015; 22(4): 708-712. doi: 10.5604/12321966.1185781 Abstract Introduction. The impact of SpO2 target ranges (TR) has been carefully studied; however, reports suggest a wide variation among infants and centres in maintaining the intended range. Little is known about the effectiveness of different approaches to manual control. Auto-SpO2 controllers are now available which show promise. Objective. The aim was to compare two different protocol-driven manual strategies with different response requirements to each other, and a faster automated system (AveaCLiO2, Yorba Linda, CA, USA). Materials and methods. In a crossover design, each of the three FiO2/SpO2 approaches was implemented in three randomly assigned consecutive 2.5-hour runs. The two manual strategies (Attentive and Observational) were implemented by a trained operator. The primary endpoints were time in 1) SpO2 TR, 2) < 80% SpO2 and 3) >98% SpO2. Results. Fifteen studies were completed. All three approaches resulted in good control, with time in the target range >60%. CLiO2 use reflected reduced exposure at the two SpO2 extremes. Post hoc analysis determined that the differences were more marked in the infants with more frequent desaturations. Likewise, in this group, the Attentive strategy performed better than the Observative. Conclusions. All three approaches provided excellent control of SpO2 in infants with infrequent desaturations, significantly better than typical routine care. In hard to manage infants with frequent desaturations, faster response appeared to result in better control. The potential of automating the tedious error prone FiO2 adjustment offers significant promise. If manual titration of FiO2 is to remain the usual method of care, additional studies are needed to identify optimal approaches.

Effect of Conventional High Flow Oxygen Therapy Compared to Conservative Oxygen Therapy in Mechanically Ventilated Neonates

“…But the aim of ventilation should be use with maximum FiO 2 for short duration and lowest possible pressure with minimum FiO 2 to maintain oxygenation for longer period. 11 FiO 2 requirement 14 We observed this situation in our study also.…”

Clinical evaluation of a novel adaptive algorithm for automated control of oxygen therapy in preterm infants on non-invasive respiratory support

“…Numerically, this amounted to a greater divergence between automated and routine manual control in relation to time in the desired SpO 2 range than has been noted in other studies (25% as against 24%,9 16%,10 13%,15 11%,12 9%,8 8%,11 7%,13 5%14 and 4%16). The VDL1.0 algorithm also appeared to more effectively eliminate serious hypoxaemia with SpO 2 <80% (0.15% of time overall vs 0.9%,14 1%,15 2%,16 3%13 and 10%11), and iatrogenic hyperoxaemia with SpO 2 >98% in oxygen (0.13% vs 0.2%,16 0.4%,14 0.7%11 and 3%10). These comparisons between studies are presented with the acknowledgement that the propensity to SpO 2 instability among the infants, and assiduousness of the caregivers in providing manual control, are likely to have differed between them.…”

Automated FiO2-SpO2 control system in Neonates requiring respiratory support: a comparison of a standard to a narrow SpO2 control range

“…In a previous crossover study we compared CLiO2 with two difference manual control strategies in 15 infants during 8-hour test periods [ 18 ]. We found that the relative effectiveness of automated control was much more pronounced in infants experiencing frequent severe desaturations.…”