title: Multicenter crossover study of automated control of inspired oxygen in ventilated preterm infants.
abstract: OBJECTIVE
  To determine the efficacy and safety of automated adjustment of the fraction of inspired oxygen (Fio(2)) adjustment in maintaining arterial oxygen saturation (Spo(2)) within an intended range for mechanically ventilated preterm infants with frequent episodes of decreased Spo(2).
  
  
  METHODS
  Thirty-two infants (gestational age [median and interquartile range]: 25 weeks [24-27 weeks]; age: 27 days [17-36 days]) were studied during 2 consecutive 24-hour periods, one with Fio(2) adjusted by clinical staff members (manual) and the other by an automated system (automated), in random sequence.
  
  
  RESULTS
  Time with Spo(2) within the intended range (87%-93%) increased significantly during the automated period, compared with the manual period (40% ± 14% vs 32% ± 13% [mean ± SD]). Times with Spo(2) of >93% or >98% were significantly reduced during the automated period (21% ± 20% vs 37% ± 12% and 0.7% vs 5.6% [interquartile ranges: 0.1%-7.2% and 2.7%-11.2%], respectively). Time with Spo(2) of <87% increased significantly during the automated period (32% ± 12% vs 23% ± 9%), with more-frequent episodes with Spo(2) between 80% and 86%, whereas times with Spo(2) of <80% or <75% did not differ between periods. Hourly median Fio(2) values throughout the automated period were lower and there were substantially fewer manual Fio(2) changes (10 ± 9 vs 112 ± 59 changes per 24 hours; P < .001), compared with the manual period.
  
  
  CONCLUSIONS
  In infants with fluctuations in Spo(2), automated Fio(2) adjustment improved maintenance of the intended Spo(2) range led to reduced time with high Spo(2) and more-frequent episodes with Spo(2) between 80% and 86%.
authors.affiliation: University of Miami, Miller School of Medicine, Department of Pediatrics, Division of Neonatology, PO Box 016960, R-131, Miami, FL 33101, USA. nclaure@miami.edu
authors.forename: Nelson
authors.initials: N
authors.lastname: Claure
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bancalari
authors.forename: Carmen
authors.initials: C
authors.lastname: D'Ugard
authors.forename: Leif
authors.initials: L
authors.lastname: Nelin
authors.forename: Melanie
authors.initials: M
authors.lastname: Stein
authors.forename: Rangasamy
authors.initials: R
authors.lastname: Ramanathan
authors.forename: Richard
authors.initials: R
authors.lastname: Hernandez
authors.forename: Steven M
authors.initials: SM
authors.lastname: Donn
authors.forename: Michael
authors.initials: M
authors.lastname: Becker
authors.forename: Thomas
authors.initials: T
authors.lastname: Bachman
mesh_terms: D018592:Cross-Over Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D010100:Oxygen / Q000008:administration & dosage*; D012121:Respiration, Artificial / Q000379:methods*
chemical_list: D010100:Oxygen