The novel PID algorithm was very effective for automated oxygen control in preterm infants, and deserves further investigation.
Background The factors influencing the severity of apnea‐related hypoxemia and bradycardia are incompletely characterized, especially in infants receiving noninvasive respiratory support. Objectives To identify the frequency and predictors of physiological instability (hypoxemia—oxygen saturation (SpO2) <80%, or bradycardia—heart rate (HR) < 100 bpm) following respiratory pauses in infants receiving noninvasive respiratory support. Methods Respiratory pause duration, derived from capsule pneumography, was measured in 30 preterm infants of gestation 30 (24‐32) weeks [median (interquartile range)] receiving noninvasive respiratory support and supplemental oxygen. For identified pauses of 5 to 29 seconds duration, we measured the magnitude and duration of SpO2 and HR reductions over a period starting at the pause onset and ending 60 seconds after resumption of breathing. Temporally clustered pauses (<60 seconds separation) were analyzed separately. The relative contribution of respiratory pauses to overall physiological instability was determined, and predictors of instability were sought in regression analysis, including demographic, clinical and situational variables as inputs. Results In total, 17 105 isolated and 9180 clustered pauses were identified. Hypoxemia and bradycardia were more likely after longer duration and temporally‐clustered pauses. However, the majority of such episodes occurred after 5 to 9 second pauses given their numerical preponderance, and short‐lived pauses made a substantial contribution to physiological instability overall. Birth gestation, hemoglobin concentration, form of respiratory support, caffeine treatment, respiratory pause duration and temporal clustering were identified as predictors of instability. Conclusions Brief respiratory pauses, especially when clustered, contribute substantially to hypoxemia and bradycardia in preterm infants.
ObjectiveTo evaluate the performance of a rapidly responsive adaptive algorithm (VDL1.1) for automated oxygen control in preterm infants with respiratory insufficiency.DesignInterventional cross-over study of a 24-hour period of automated oxygen control compared with aggregated data from two flanking periods of manual control (12 hours each).SettingNeonatal intensive care unit.ParticipantsPreterm infants receiving non-invasive respiratory support and supplemental oxygen; median birth gestation 27 weeks (IQR 26–28) and postnatal age 17 (12–23) days.InterventionAutomated oxygen titration with the VDL1.1 algorithm, with the incoming SpO2 signal derived from a standard oximetry probe, and the computed inspired oxygen concentration (FiO2) adjustments actuated by a motorised blender. The desired SpO2 range was 90%–94%, with bedside clinicians able to make corrective manual FiO2 adjustments at all times.Main outcome measuresTarget range (TR) time (SpO2 90%–94% or 90%–100% if in air), periods of SpO2 deviation, number of manual FiO2 adjustments and oxygen requirement were compared between automated and manual control periods.ResultsIn 60 cross-over studies in 35 infants, automated oxygen titration resulted in greater TR time (manual 58 (51–64)% vs automated 81 (72–85)%, p<0.001), less time at both extremes of oxygenation and considerably fewer prolonged hypoxaemic and hyperoxaemic episodes. The algorithm functioned effectively in every infant. Manual FiO2 adjustments were infrequent during automated control (0.11 adjustments/hour), and oxygen requirements were similar (manual 28 (25–32)% and automated 26 (24–32)%, p=0.13).ConclusionThe VDL1.1 algorithm was safe and effective in SpO2 targeting in preterm infants on non-invasive respiratory support.Trial registration numberACTRN12616000300471.
Oxygen is one of the most commonly used therapies in neonatology but optimum oxygen saturations for preterm infants have been debated for the past 50 years. The history of oxygen use in this population and multiple clinical trials over the years have shown that liberal oxygen administration is associated with retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD) whereas restrictive use results in increased mortality and neurodisability. Pulse oximetry (SpO 2) is a bedside tool to guide the fraction of inspired oxygen (FiO 2) delivered to the patient, and is the current standard of care for continuous monitoring. Although evidence favours targeting predetermined oxygen saturation ranges, achieving this goal consistently in clinical practice has been challenging due to intrinsic pulmonary immaturity, the need for respiratory support therapies and factors relating to the bedside caregivers ability to adjust FiO 2. This review article focuses on the difficulties of titrating oxygen therapy in this vulnerable group and provides recommendations for the best practice based on up to date evidence.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.