MS # 20171964 / van den Heuvel - Goldilocks in the NICU—can oxygen be titrated “just right?”

Abstract

Oxygen is the most commonly used “drug” for preterm infants, and recent large clinical trials highlight the need for careful titration within a narrow therapeutic window. In particular, lower achieved oxygen saturations are associated with increased mortality in extremely preterm infants, possibly due to more time spent in extreme hypoxemia. Automated systems that adjust the inspired oxygen based on the detected O2 saturation are a timely innovation that should improve the ease and precision of maintaining oxygenation within the desired range. Using an automated system, van den Heuvel et al found that a “narrow” target range for O2 saturation (88-92%) did not improve the time spent in the desired saturation range of 86-94%. However, the narrow range did reduce the time spent in moderate and severe hypoxemia (SpO2 <80%) and reduced the number of prolonged episodes of severe hypoxemia. Either approach was superior to manual adjustment and reduced time spent in hyperoxemia (Figure). The task of oxygen titration tends to fall on the shoulders of the busiest caregiver, the bedside nurse. Automated systems appear to go beyond relieving this burden to improve the precision and safety of oxygen therapy. Article page 36 ▶ Optimal Target Range of Closed-Loop Inspired Oxygen Support in Preterm Infants: A Randomized Cross-Over StudyThe Journal of PediatricsVol. 197PreviewTo investigate the effect of different pulse oximetry (SpO2) target range settings during automated fraction of inspired oxygen control (A-FiO2) on time spent within a clinically set SpO2 alarm range in oxygen-dependent infants on noninvasive respiratory support. Full-Text PDF