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

Anton H. Van Kaam, Helmut D. Hummler, Maria Wilinska, Janusz Swietlinski, Mithilesh K. Lal, Arjan B. Te Pas, Gianluca Lista, Samir Gupta, Carlos A. Fajardo, Wes Onland, Markus Waitz, Malgorzata Warakomska, Francesco Cavigioli, Eduardo Bancalari, Nelson Claure, Thomas E. Bachman

Research output: Contribution to journalArticlepeer-review

50 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)545-550.e2
JournalJournal of Pediatrics
Volume167
Issue number3
DOIs
StatePublished - Sep 1 2015

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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