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 R Claure, Thomas E. Bachman

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Objective To determine the efficacy and safety of automated adjustment of the fraction of inspired oxygen (FiO<inf>2</inf>) in maintaining arterial oxygen saturation (SpO<inf>2</inf>) 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 SpO<inf>2</inf> target ranges and then treated with automated FiO<inf>2</inf> (A-FiO<inf>2</inf>) and manual FiO<inf>2</inf> (M-FiO<inf>2</inf>) oxygen control for 24 hours each, in random sequence. Results The percent time within the target range was higher during A-FiO<inf>2</inf> compared with M-FiO<inf>2</inf> control. This effect was more pronounced in the lower SpO<inf>2</inf> target range (62 ± 17% vs 54 ± 16%, P <.001) than in the higher SpO<inf>2</inf> target range (62 ± 17% vs 58 ± 15%, P <.001). The percent time spent below the target or in hypoxemia (SpO<inf>2</inf> <80%) was consistently reduced during A-FiO<inf>2</inf>, independent of the target range. The time spent above the target range or at extreme hyperoxemia (SpO<inf>2</inf> >98%) was only reduced during A-FiO<inf>2</inf> when targeting the lower SpO<inf>2</inf> range (89%-93%). These outcomes did not differ between infants on noninvasive and invasive respiratory support. Manual adjustments were significantly reduced during A-FiO<inf>2</inf> control. Conclusions A-FiO<inf>2</inf> control improved SpO<inf>2</inf> targeting across different SpO<inf>2</inf> 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

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Premature Infants
Oxygen
Gestational Age
Safety

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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Van Kaam, A. H., Hummler, H. D., Wilinska, M., Swietlinski, J., Lal, M. K., Te Pas, A. B., ... Bachman, T. E. (2015). Automated versus Manual Oxygen Control with Different Saturation Targets and Modes of Respiratory Support in Preterm Infants. Journal of Pediatrics, 167(3), 545-550.e2. https://doi.org/10.1016/j.jpeds.2015.06.012

Automated versus Manual Oxygen Control with Different Saturation Targets and Modes of Respiratory Support in Preterm Infants. / Van Kaam, Anton H.; Hummler, Helmut D.; Wilinska, Maria; Swietlinski, Janusz; Lal, Mithilesh K.; Te Pas, Arjan B.; Lista, Gianluca; Gupta, Samir; Fajardo, Carlos A.; Onland, Wes; Waitz, Markus; Warakomska, Malgorzata; Cavigioli, Francesco; Bancalari, Eduardo; Claure, Nelson R; Bachman, Thomas E.

In: Journal of Pediatrics, Vol. 167, No. 3, 01.09.2015, p. 545-550.e2.

Research output: Contribution to journalArticle

Van Kaam, AH, Hummler, HD, Wilinska, M, Swietlinski, J, Lal, MK, Te Pas, AB, Lista, G, Gupta, S, Fajardo, CA, Onland, W, Waitz, M, Warakomska, M, Cavigioli, F, Bancalari, E, Claure, NR & Bachman, TE 2015, 'Automated versus Manual Oxygen Control with Different Saturation Targets and Modes of Respiratory Support in Preterm Infants', Journal of Pediatrics, vol. 167, no. 3, pp. 545-550.e2. https://doi.org/10.1016/j.jpeds.2015.06.012
Van Kaam, Anton H. ; Hummler, Helmut D. ; Wilinska, Maria ; Swietlinski, Janusz ; Lal, Mithilesh K. ; Te Pas, Arjan B. ; Lista, Gianluca ; Gupta, Samir ; Fajardo, Carlos A. ; Onland, Wes ; Waitz, Markus ; Warakomska, Malgorzata ; Cavigioli, Francesco ; Bancalari, Eduardo ; Claure, Nelson R ; Bachman, Thomas E. / Automated versus Manual Oxygen Control with Different Saturation Targets and Modes of Respiratory Support in Preterm Infants. In: Journal of Pediatrics. 2015 ; Vol. 167, No. 3. pp. 545-550.e2.
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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.",
author = "{Van Kaam}, {Anton H.} and Hummler, {Helmut D.} and Maria Wilinska and Janusz Swietlinski and Lal, {Mithilesh K.} and {Te Pas}, {Arjan B.} and Gianluca Lista and Samir Gupta and Fajardo, {Carlos A.} and Wes Onland and Markus Waitz and Malgorzata Warakomska and Francesco Cavigioli and Eduardo Bancalari and Claure, {Nelson R} and Bachman, {Thomas E.}",
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T1 - Automated versus Manual Oxygen Control with Different Saturation Targets and Modes of Respiratory Support in Preterm Infants

AU - Van Kaam, Anton H.

AU - Hummler, Helmut D.

AU - Wilinska, Maria

AU - Swietlinski, Janusz

AU - Lal, Mithilesh K.

AU - Te Pas, Arjan B.

AU - Lista, Gianluca

AU - Gupta, Samir

AU - Fajardo, Carlos A.

AU - Onland, Wes

AU - Waitz, Markus

AU - Warakomska, Malgorzata

AU - Cavigioli, Francesco

AU - Bancalari, Eduardo

AU - Claure, Nelson R

AU - Bachman, Thomas E.

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N2 - 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.

AB - 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.

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