Achieved Versus Intended Pulse Oximeter Saturation in Infants Born Less Than 28 Weeks' Gestation: The AVIOx Study

Hagadorn, James I.; Furey, Anne; Nghiem, Tuyet-Hang; Schmid, Christopher H.; Phelps, Dale L.; Pillers, De-Ann M.; Cole, Cynthia H.

doi:10.1542/peds.2005-0413

Cited by 226 publications

(169 citation statements)

References 19 publications

Supporting

Mentioning

157

Contrasting

Order By: Relevance

“…Most closed loop studies compared automated to routine clinical care (14,21,(24)(25)(26), only one study could show a significant improvement comparing closed loop to dedicated manual control (22). In addition, in our study, alarm range was equal to target range, which created an ideal setting for dedicated manual control as caregivers are more effective in keeping SpO 2 within alarm limits then within target limits in preterm infants (32). Interestingly, our data suggest that keeping animals manually within the limits was more difficult with high oxygen need, while individual oxygen need did not influence the performance of the automated control.…”

Section: Discussionmentioning

confidence: 81%

“…The average number of adjustments during resuscitation was similar in both groups (median 27, IQR (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) vs. 28 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36); P = 0.796). (Figure 1b), however the oxygen need was highly variable in both the automated (IQR (0.52-0.98)) and the manual group (IQR (0.37-0.72)).…”

Section: Resuscitationmentioning

confidence: 92%

See 1 more Smart Citation

Fully automated predictive intelligent control of oxygenation (PRICO) in resuscitation and ventilation of preterm lambs

et al. 2015

View full text Add to dashboard Cite

Articles Translational Investigation nature publishing groupBackground: Hyperoxia and hypoxia influence morbidity and mortality of preterm infants. Automated closed-loop control of the fraction of inspired oxygen (FiO 2 ) has been shown to facilitate oxygen supplementation in the neonatal intensive care unit (NICU), but has not yet been tested during preterm resuscitation. We hypothesized that fully automated FiO 2 control based on predefined oxygen saturation (SpO 2 ) targets was applicable in both preterm resuscitation and ventilation. Methods: Twenty-two preterm lambs were operatively delivered and intubated in a modified EXIT procedure. They were randomized to receive standardized resuscitation with either automated or manual FiO 2 control, targeting SpO 2 according to the Dawson curve in the first 10 min and SpO 2 90-95% hereafter. Automated FiO 2 control also was applied during surfactant replacement therapy and subsequent ventilation. results: Time within target range did not differ significantly between manual and automated FiO 2 control during resuscitation, however automated FiO 2 control significantly avoided hyperoxia. Automated FiO 2 control was feasible during surfactant replacement and kept SpO 2 within target range significantly better than manual control during subsequent ventilation. conclusion: In our model, fully automated FiO 2 control was feasible in rapidly changing physiologic conditions during postnatal resuscitation and prevented hyperoxia. We conclude that closed loop FiO 2 control is a promising tool for the delivery room.o xygen supplementation is one of the most common therapeutic interventions in resuscitation and neonatal intensive care of term and preterm infants (1). However, both hypoxia and hyperoxia must be avoided because of their detrimental effects on morbidity and mortality in these children. While hypoxia may lead to direct and indirect cellular damage, hyperoxia has been associated with oxygen toxicity, oxidative stress (2), and chronic diseases of preterm infants such as bronchopulmonary dysplasia (3) and retinopathy of prematurity (4).Increase in oxygenation after birth is a gradual process (5). Measurement of oxygen saturation (SpO 2 ) by pulse oximetry in the delivery room is feasible in newborn resuscitation (6) and in preterm infants within the first minutes of life (7). SpO 2 reference values of preterm infants increase within the first 10 min of life (5). This has led to SpO 2 target values incorporated in the current European Resuscitation Council guidelines on resuscitation of newborns (8). In order to avoid hyperoxia, current recommendations advise resuscitation of preterm infants with a mixture of air and oxygen, and to use fraction of inspired oxygen (FiO 2 ) between 0.21 and 0.30 (9). FiO 2 should subsequently be titrated according to SpO 2 (10,11). General use of pulse oximetry has been shown to extensively reduce O 2 -derived toxicity in preterm infants (12). However, keeping SpO 2 manually within changing saturation limits during a hectic period of resu...

show abstract

Section: Discussionmentioning

confidence: 81%

Section: Resuscitationmentioning

confidence: 92%

Fully automated predictive intelligent control of oxygenation (PRICO) in resuscitation and ventilation of preterm lambs

et al. 2015

View full text Add to dashboard Cite

show abstract

“…12 Studies that compare actual versus intended pulse oxygen saturation in very preterm infants have shown that poor compliance with the desired range of oxygen saturation target values and with alarm limits for pulse oximetry is an important and common problem in NICUs worldwide. [13][14][15][16][17] However, our neonatal team has maintained COT study participants within the intended pulse oximetry alarm limits between 68 and 79% of the time. Although our teams' performance is among the best of all neonatal units participating in the COT study, it needs to be highlighted that we only measured compliance during the first 3 days of life while infants were receiving supplemental oxygen.…”

Section: /41mentioning

confidence: 99%

“…However, a multicenter study that measured compliance during the first 4 weeks of life found no significant association of the target range compliance with chronological age, mechanical ventilator status, pulmonary acuity score, birth weight and severity of illness at birth. 13 Nevertheless, when discussing the results of oxygen saturation studies, it should be done in respect of the duration of the monitoring. Hagadorn et al 13 prospectively compared the achieved SpO 2 with the intended range in a cohort of 84 infants, <28 weeks gestation, during the first 4 weeks of life in 14 centers and three countries.…”

Section: /41mentioning

confidence: 99%

“…13 Nevertheless, when discussing the results of oxygen saturation studies, it should be done in respect of the duration of the monitoring. Hagadorn et al 13 prospectively compared the achieved SpO 2 with the intended range in a cohort of 84 infants, <28 weeks gestation, during the first 4 weeks of life in 14 centers and three countries. Local policies varied between 83 and 92% for lower pulse oximetry alarm limits and 92 and 98% for upper limits.…”

Section: /41mentioning

confidence: 99%

See 1 more Smart Citation

Nurses’ compliance with alarm limits for pulse oximetry: qualitative study

et al. 2009

View full text Add to dashboard Cite

Objective: Monthly audits for the multicenter Canadian Oxygen Trial have shown that our neonatal team has consistently maintained study participants within the intended pulse oximetry alarm limits between 68 and 79% of the time during the first 3 days of life while infants were receiving supplemental oxygen. This good performance prompted us to explore our nurses' perceptions of what makes them compliant with alarm limits for pulse oximetry in preterm infants.Study Design: The local neonatal research nurse interviewed all 41 staff nurses in the neonatal intensive care unit at the University Children's Hospital in Tuebingen, Germany, for this qualitative study.Result: Nurses identified education (22/41), prompt response to alarms (22/41), a favorable patient-to-staff ratio (18/41), root cause analysis at the bedside (15/41), and the high priority given to control of oxygen therapy in the department (14/41) as the five most important determinants of their good compliance.Conclusion: These findings may be useful for other neonatal teams who struggle to improve their compliance with alarm limits for pulse oximetry.

show abstract

Effects of Targeting Higher vs Lower Arterial Oxygen Saturations on Death or Disability in Extremely Preterm Infants

Schmidt

Whyte²,

Asztalos³

et al. 2013

JAMA

374

305

View full text Add to dashboard Cite

for the Canadian Oxygen Trial (COT) Group E XTREMELY PRETERM INFANTS are monitored with pulse oximeters for several weeks after birth because they may require supplemental oxygen intermittently or continuously. The goal of oxygen therapy is to deliver sufficient oxygen to the tissues while minimizing oxygen toxicity and oxidative stress. It remains uncertain what values of arterial oxygen saturations achieve this balance in immature infants, who are especially vulnerable to the harmful effects of oxygen. 1-7 Oxygen therapy for preterm infants was introduced in the 1940s. In the 1950s, after approximately 10 000 preterm children had been blinded, randomized trials confirmed that liberal oxygen therapy may cause retinopathy of prematurity. 8 In the 1960s, oxygen therapy was restricted and many nurseries adopted arbitrary upper limits for Author Affiliations are listed at the end of this article.

show abstract

Achieved Versus Intended Pulse Oximeter Saturation in Infants Born Less Than 28 Weeks' Gestation: The AVIOx Study

Cited by 226 publications

References 19 publications

Fully automated predictive intelligent control of oxygenation (PRICO) in resuscitation and ventilation of preterm lambs

Fully automated predictive intelligent control of oxygenation (PRICO) in resuscitation and ventilation of preterm lambs

Nurses’ compliance with alarm limits for pulse oximetry: qualitative study

Effects of Targeting Higher vs Lower Arterial Oxygen Saturations on Death or Disability in Extremely Preterm Infants

Contact Info

Product

Resources

About