The effect of implementing an automated oxygen control on oxygen saturation in preterm infants

Abstract

During oxygen therapy, preterm infants spent more time within the SpO target range after implementation of automated oxygen control, with a significant reduction in hyperoxaemia, but not hypoxaemia.

Automated control of inspired oxygen (FiO2) in preterm infants: Literature review

“…Thus, it seems that automated control is more effective in preventing hyperoxia than hypoxia in comparison with manual control. On the other hand, there was great variability in the time spent with SpO 2 higher or lower than target: the first changes from 5% to 28% for automated control and from 10% to 43% for manual control; the second changes from 5% to 33% for automated control and from 8% to 27% for manual control.…”

“…The main characteristics of selected studies are summarized in the Table . We found 16 studies on the effectiveness of automated control of inspired oxygen (FiO 2 ) in preterm infants: twelve were randomized, two were retrospective, and one was a prospective study; one study did not report the design . Mostly, these studies have a crossover design and compare the effectiveness of automated versus manual control in maintaining the target SpO 2 in the same patient during two consecutive periods in random sequence .…”

“…Overall, the population size was small with the exception of one retrospective study ( n = 121) which reports on the use of automated oxygen delivery control in preterm infants in Poland without detailing its effectiveness and possible advantages . Patients’ gestational age at enrollment was mostly <30 weeks, while age at study entry was more frequently <40 days of life . The study duration ranged from 1.5 to 48 h, while infants were receiving mechanical ventilation, mechanical ventilation or non‐invasive support (including nasal continuous positive airway pressure and nasal intermittent positive pressure ventilation), and non‐invasive support (including high‐flow nasal cannula, nasal continuous positive airway pressure, and nasal intermittent positive pressure ventilation) …”

“…Subsequently, Claure et al used a mechanical ventilator (Avea ® , Viasys Healthcare, CA) with a built‐in automated FiO 2 adjustment function which maintains patients’ SpO 2 (Radical Masimo ® ) using an algorithm whose operating principles were similar to the aforementioned . The development of this investigational device lead to the commercial availability of the AVEA‐CLiO 2 ® (CareFusion, Yorba Linda, CA), that is one of the most diffuse systems for automated control of oxygen delivery …”

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

“…Modern ventilators now also have the option of servo-controlled oxygen delivery. This increases time spent in the desired saturation range and reduces hyperoxia, but there are no trials to show this improves outcomes [115, 116]. Whatever ventilation mode is used within an individual unit, it is important that all staff are familiar with its use.…”