Elsevier

The Journal of Pediatrics

Volume 166, Issue 2, February 2015, Pages 240-244.e1
The Journal of Pediatrics

Original Article
Effects of Automated Adjustment of the Inspired Oxygen on Fluctuations of Arterial and Regional Cerebral Tissue Oxygenation in Preterm Infants with Frequent Desaturations

https://doi.org/10.1016/j.jpeds.2014.10.007Get rights and content

Objective

To assess the effect of automated adjustment of the inspired oxygen fraction (FiO2) on arterial oxygen saturation (SpO2) and cerebral tissue oxygen saturation (SctO2) in very low birth weight infants with frequent fluctuations in oxygenation.

Study design

Fifteen infants (median gestational age, 25 weeks [range, 23-28 weeks]; median age, 34 days [range, 19-74 days]) were assigned in random sequence to 24 hours of automated adjustment of FiO2 or manual adjustment of FiO2. Primary outcome measurements were time within the SpO2 target range and the area under the curve above and below a defined SctO2 range.

Results

Percentage of time within the SpO2 target range increased during automated FiO2 control (76.3% ± 9.2% vs 69.1% ± 8.2% for manual; P < .01). Prolonged episodes with SpO2 <88% of >60 seconds duration (median, 115 episodes [range, 67-240] vs 54 episodes [range, 7-184]; P < .01) and of >180 seconds duration (median, 13 episodes [range, 6-39] vs 2 episodes [range, 0-5]; P < .01) decreased significantly during the automated period. Percentage of time with SpO2 >96% decreased during automated control (6.6% ± 4.4% vs 10.4% ± 3.3%; P < .02). There was no significant difference in FiO2 exposure. The area (deviation × time) below and above the defined SctO2 threshold did not differ between the 2 periods (median, 59.7%*seconds [range, 17.2%-208.3%] for manual vs 49.0%*seconds [range, 4.3%-193.7%] for automated; P = .36).

Conclusion

Automated FiO2 control in preterm infants with frequent SpO2 fluctuations significantly increased the time within the SpO2 target range and reduced the incidence of prolonged hypoxemic events compared with manual FiO2 adjustment, but did not significantly affect cerebral tissue oxygenation.

Section snippets

Methods

This study was a randomized cross-over clinical trial comparing 2 treatment phases, clinical routine and automated adjustment of FiO2, each of 24 hours duration. Infants were recruited in the neonatal intensive care unit of the children's hospital at Ulm University Medical Center. Inclusion criteria were gestational age <30 weeks, receipt of nasal/nasopharyngeal continuous positive airway pressure or mechanical ventilation (including nasopharyngeal intermittent mandatory ventilation), more than

Results

A total of 15 preterm infants with intermittent hypoxemia were included from February 2012 through June 2013. Characteristics of the study group are summarized in Table II. The primary outcome of time within the SpO2 target range increased significantly during the automated period compared with the manual period (Table III). During automated FiO2 control, the percentage of time above the SpO2 target range was significantly reduced, there was a tendency toward less time below the SpO2 range, and

Discussion

In this study, we evaluated the effect of an automated FiO2 adjustment compared with routine FiO2 control on SpO2 and SctO2 in preterm infants with intermittent hypoxemia. We found a significant improvement in time within the intended SpO2 target range during the automated FiO2 control period. The time that infants spent within the intended SpO2 range increased significantly, and was accompanied by a reduced proportion of time in hyperoxemia and a trend toward less time with hypoxemia during

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Funded by the German Bundesministerium für Wirtschaft und Technologie (KF303190IMD2). The authors declare no conflicts of interest.

Registered with ClinicalTrials.gov: NCT01942473.

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