Abstract
BackgroundManaging the oxygen saturation of preterm infants to a target range has been the standard of care for a decade. Changes in target ranges have been shown to significantly impact mortality and morbidity. Selecting and implementing the optimal target range are complicated not only by issues of training, but also the realities of staffing levels and demands. The potential for automatic control is becoming a reality. Results from the evaluation of different systems have been promising and our own experience encouraging.MethodsThis study was conducted in two tertiary level newborn nurseries, routinely using an automated FiO2-SpO2 control system (Avea-CLiO2, Yorba Linda CA, USA). The aim of this study was to compare the performance of the system as used routinely (set control range of 87-93% SpO2), to a narrower higher range (90-93%). We employed a 12-hour cross-over design with the order of control ranges randomly assigned for each of up to three days. The primary prospectively identified end points were time in the 87-93% SpO2 target range, time at SpO2 extremes and the distribution of the SpO2 exposure.ResultsTwenty-one infants completed the study. The infants were born with a median EGA of 27 weeks and studied at a median age of 17 days and weight of 1.08 kg. Their median FiO2 was 0.32; 8 were intubated, and the rest noninvasively supported (7 positive pressure ventilation and 6 CPAP). The control in both arms was excellent, and required less than 2 manual FiO2 adjustments per day. There were no differences in the three primary endpoints. The narrower/higher set control range resulted in tighter control (IQR 3.0 vs. 4.3 p < 0.001), and less time with the SpO2 between 80–86 (6.2% vs. 8.4%, p = 0.006).ConclusionsWe found that a shift in the median of the set control range of an automated FiO2-SpO2 control system had a proportional effect on the median and distribution of SpO2 exposure. We found that a dramatic narrowing of the set control range had a disproportionally smaller impact. Our study points to the potential to optimize SpO2 targeting with an automated control system.
Highlights
Managing the oxygen saturation of preterm infants to a target range has been the standard of care for a decade
We suggest that our study demonstrates the potential to use automated control ranges that are narrower or shifted to impact changes in SpO2 exposure
We further suggest that the ability of automated SpO2-Fraction of inspired oxygen (FiO2) control to reduce the time below the SpO2 target range, might reduce the risk of this problem as seen in McEvoy’s study and other studies of SpO2 targeting
Summary
Managing the oxygen saturation of preterm infants to a target range has been the standard of care for a decade. Managing SpO2 to a target range rather than just increasing FiO2 in response to an episode of desaturation became the standard of care more than a decade ago. Applying the results of this targeting evidence is challenging because of the difference between the SpO2 target range specified and the SpO2 exposure achieved. Selecting the optimal clinical SpO2 target range is complicated by the realities of manual titration of FiO2 in the busy newborn ICU [10,11,12]. Such systems can make adjustments to FiO2 as often as every second. Automation of SpO2-FiO2 control, because it does not require constant nursing intervention, makes it practical to consider different paradigms for management of SpO2 exposure
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