Automated adjustment of inspired oxygen in preterm infants with frequent fluctuations in oxygenation: a pilot clinical trial.
OBJECTIVE
To assess the efficacy of a system for automated fraction of inspired oxygen (FiO(2)) adjustment in maintaining oxygen saturation (SpO(2)) within an intended range in preterm infants with spontaneous fluctuations in SpO(2).


METHODS
Sixteen infants (gestational age, 24.9 +/- 1.4 weeks; birth weight, 678 +/- 144 g; age, 33 +/- 15 days) with frequent hypoxemia episodes underwent two 4-hour periods of FiO(2) adjustment by clinical personnel (routine) and the automated system (automated).


RESULTS
Compared with the routine period, the percent time within intended SpO(2) range (88%-95%) increased during the automated period (58% +/- 10% versus 42% +/- 9%; P < .001), whereas the percent time with SpO(2) higher than the intended range and >or=98% were reduced (9% +/- 10% versus 31% +/- 8% [P < .001] and 3% +/- 5% versus 16% +/- 9% [P < .001], respectively). Percent time with SpO(2) < 88% increased during the automated period (33% +/- 7% versus 27% +/- 9%; P = .003) because of more frequent episodes, whereas the time with SpO(2) < 75% did not differ. The 4-hour median FiO(2) was lower during the automated period (29% +/- 4% versus 34% +/- 5%; P < .001).


CONCLUSIONS
Automated FiO(2) adjustment improved maintenance of SpO(2) within the intended range and reduced hyperoxemia and FiO(2). These findings should be examined in longer periods with standard clinical conditions and, eventually, in the context of randomized trials powered to detect clinically important effects on outcome.
Claure
Nelson
N
Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL 33101, USA. nclaure@miami.edu
D'Ugard
Carmen
C
Bancalari
Eduardo
E
D001331:Automation; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D010092:Oximetry; D010100:Oxygen / Q000627:therapeutic use; D010101:Oxygen Consumption / Q000502:physiology; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D010865:Pilot Projects; D011247:Pregnancy; D011336:Probability; D012123:Pulmonary Ventilation; D012121:Respiration, Artificial / Q000379:methods*; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000628:therapy; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D010100:Oxygen