Computer-assisted adjustment of inspired oxygen concentration improves control of oxygen saturation in newborn infants requiring mechanical ventilation☆,☆☆
Section snippets
Methods
The clinical trial was implemented in two neonatal intensive care units after institutional review board approval. Informed consent was obtained from the parents of all enrolled patients. Patients were eligible if they required supplemental oxygen and mechanical ventilation. Patients were excluded if they had significant pulmonary hypertension or if they required vasoactive medications to maintain blood pressure.
A target Sa o2 was selected for each subject by the primary care team. The trial
Results
Characteristics of the 16 patients enrolled in the study are summarized in the Table.
Patient No. GA (wk) BW (gm) Age at study (d) Diagnosis Sa o2 (%) F io2 (%) 1 32 1510 101 TEF/esophageal atresia 93 24 2 28 1070 20 Pneumothorax 93 64 3 30 1460 5 RDS 93 21 4 28 700 24 TEF/esophageal atresia, sepsis 93 29 5 32 2400 8 Omphalocele, ASD, aortic coarctation 95 43 6 27 1265 19 Cystic adenomatoid malfor- mation of left lung 93 27 7 41 4000 14 Camptomelic dysplasia 93 23 8 27 770 16 RDS 95 28 9 30 1240 5 RDS 93 31 10 26 1030 20 RDS 92 53 11 25 780 13 RDS
Discussion
We tested a newly designed computer-assisted F io2 control system in newborn infants requiring mechanical ventilation. To our knowledge, our study is the first controlled trial that shows significantly improved control of Sa o2 when using computerized F io2 adjustment compared with routine manual care. Morozoff and Evans 3 tested a computerized F io2 controller in newborn infants requiring mechanical ventilation but did not show improved control of Sa o2 . Bhutani et al. 4 tested an automated F
Acknowledgements
We thank Dr. Eric Eichenwald and Professor Peter Szolovits for their critical review of this manuscript and Dr. Friedrich Steinman for his initial encouragement to investigate fuzzy logic control. We also thank the nursing and medical staff of Children’s Hospital and Brigham and Women’s Hospital neonatal intensive care units.
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Cited by (36)
New Perspectives in Oxygen Therapy Titration: Is Automatic Titration the Future?
2019, Archivos de BronconeumologiaAutomation of Respiratory Support
2018, The Newborn Lung: Neonatology Questions and Controversies, Third EditionAutomated control of inspired oxygen for preterm infants: What we have and what we need
2016, Biomedical Signal Processing and ControlCitation Excerpt :As an example, Urschitz et al. [17] initially tested their algorithm on preterm infants supported with nasal continuous positive airway pressure but later [21] on patients receiving mechanical ventilation and CPAP. Similarly, Sun et al. [22] reported some preliminary clinical results, before testing the algorithm in open loop on 16 mechanically ventilated infants [25]. Lopez et al. [24] used a first-order model of FiO2–SpO2 relationship for their preliminary tests on their controller and later reported the results of a randomised controlled trial [26].
Closed-loop control of inspired oxygen in premature infants
2015, Seminars in Fetal and Neonatal MedicineCitation Excerpt :These algorithms can also include adjustments in FiO2 based on upward or downward trends in SpO2 or the time during which SpO2 is out of the target range. The efficacy of closed-loop FiO2 systems has been compared to manual FiO2 control by routine care or a fully dedicated caregiver in single and multicenter clinical studies [39–54]. These studies showed that closed-loop FiO2 control systems were consistently more effective than manual control in maintaining the oxygenation targets and were similar or better than a caregiver fully dedicated to FiO2 titration (Table 1).
Control of oxygenation during mechanical ventilation in the premature infant
2012, Clinics in PerinatologyCitation Excerpt :Aware of the intense effort required to maintain oxygen saturations in these infants and limitations in staffing during routine neonatal care, several groups of investigators have developed automated systems that can perform this repetitive task without the constant presence of a bedside nurse or respiratory therapist. All these systems have achieved a significant improvement in time within target when compared with manual control.24–32 As expected, this advantage was more striking when the automated systems were compared with routine care rather than those studies that had a dedicated nurse at the bedside.
Automation of Respiratory Support
2012, The Newborn Lung: Neonatology Questions and Controversies Expert Consult
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Reprint requests: Yao Sun, MD, CWN-418, Brigham & Women’s Hospital, 75 Francis Street, Boston, MA 02115.
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