title: Automated versus Manual Oxygen Control with Different Saturation Targets and Modes of Respiratory Support in Preterm Infants.
abstract: OBJECTIVE
  To determine the efficacy and safety of automated adjustment of the fraction of inspired oxygen (FiO2) in maintaining arterial oxygen saturation (SpO2) within a higher (91%-95%) and a lower (89%-93%) target range in preterm infants.
  
  
  METHODS
  Eighty preterm infants (gestational age [median]: 26 weeks, age [median] 18 days) on noninvasive (n = 50) and invasive (n = 30) respiratory support with supplemental oxygen, were first randomized to one of the SpO2 target ranges and then treated with automated FiO2 (A-FiO2) and manual FiO2 (M-FiO2) oxygen control for 24 hours each, in random sequence.
  
  
  RESULTS
  The percent time within the target range was higher during A-FiO2 compared with M-FiO2 control. This effect was more pronounced in the lower SpO2 target range (62 ± 17% vs 54 ± 16%, P < .001) than in the higher SpO2 target range (62 ± 17% vs 58 ± 15%, P < .001). The percent time spent below the target or in hypoxemia (SpO2 <80%) was consistently reduced during A-FiO2, independent of the target range. The time spent above the target range or at extreme hyperoxemia (SpO2 >98%) was only reduced during A-FiO2 when targeting the lower SpO2 range (89%-93%). These outcomes did not differ between infants on noninvasive and invasive respiratory support. Manual adjustments were significantly reduced during A-FiO2 control.
  
  
  CONCLUSIONS
  A-FiO2 control improved SpO2 targeting across different SpO2 ranges and reduced hypoxemia in preterm infants on noninvasive and invasive respiratory support.
  
  
  BACKGROUND
  ISRCTN 56626482.
authors.affiliation: Emma Children's Hospital AMC, Amsterdam, The Netherlands.
authors.forename: Anton H
authors.initials: AH
authors.lastname: van Kaam
authors.affiliation: University Medical Center, Ulm, Germany.
authors.forename: Helmut D
authors.initials: HD
authors.lastname: Hummler
authors.affiliation: The Medical Center of Postgraduate Education, Warsaw, Poland.
authors.forename: Maria
authors.initials: M
authors.lastname: Wilinska
authors.affiliation: Silesian Institute Mother and Newborn, Chorzow, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Swietlinski
authors.affiliation: James Cook University Hospital, Middlesbrough, United Kingdom.
authors.forename: Mithilesh K
authors.initials: MK
authors.lastname: Lal
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Arjan B
authors.initials: AB
authors.lastname: te Pas
authors.affiliation: Vittore Buzzi Children's Hospital, Milano, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Lista
authors.affiliation: University Hospital North Tees, Stockton, Cleveland, United Kingdom.
authors.forename: Samir
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Alberta Children's Hospital, Calgary, Canada.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Fajardo
authors.affiliation: Emma Children's Hospital AMC, Amsterdam, The Netherlands.
authors.forename: Wes
authors.initials: W
authors.lastname: Onland
authors.affiliation: University Medical Center, Ulm, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Waitz
authors.affiliation: The Medical Center of Postgraduate Education, Warsaw, Poland.
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Warakomska
authors.affiliation: Vittore Buzzi Children's Hospital, Milano, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavigioli
authors.affiliation: University of Miami, Miami, FL.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bancalari
authors.affiliation: University of Miami, Miami, FL.
authors.forename: Nelson
authors.initials: N
authors.lastname: Claure
authors.affiliation: Czech Technical University in Prague, Prague, Czech Republic; Economedtrx, Lake Arrowhead, CA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Bachman
mesh_terms: D002170:Canada; D018592:Cross-Over Studies; D005060:Europe; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D010092:Oximetry / Q000379:methods*; D010100:Oxygen / Q000097:blood* / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000379:methods*
chemical_list: D010100:Oxygen