Automated Closed Loop Control of Inspired Oxygen Concentration

Abstract

Oxygen therapy is extensively used in premature infants and adults with respiratory insufficiency. In the premature infant the goal during manual control of the F IO 2 is to maintain adequate oxygenation and to minimize the exposure to hypoxemia, hyperoxemia, and oxygen. However, this is frequently not achieved during routine care, which increases the risks of associated side effects affecting the eye, lungs, and central nervous system. In the adult the primary goal is to avoid hypoxemia, but conventional methods of oxygen supplementation may fall short during periods of increased demand. On the other hand, there are growing concerns related to unnecessarily high F IO 2 levels that increase the exposure to hyperoxemia and excessive oxygen use in settings where resources are limited. Systems for automated closed loop control of F IO 2 have been developed for use in neonates and adults. This paper will give an overview of the rationale for the development of these systems, present the evidence, and discuss important advantages and limitations.

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

“…Hypoventilation after episodes of active breathing during mechanical ventilation has been previously described as important contributor to desaturations Step size adjuster Safety check in ventilated preterm children (36). Automated FiO 2 control might be ineffective in prevention of hypoxic spells (27). However, our data suggest that automated control prevented episodes below target and might therefore have an effect on these episodes, as hypoxic spells have been associated with lower average SpO 2 levels (37).…”

“…Several clinical trials with different devices have proven feasibility of automated closed loop FiO 2 control in the NICU for various modes of ventilation, mixed populations, and by using different algorithms (14,(21)(22)(23)(24)(25)(26). In addition, an overall reduction of manual interventions during automated control was found in these studies, indicating facilitation of caretakers and nursing staff in clinical routine (27,28). However, at least one study raised concerns about safety, as time within target range was accompanied by an increase in time spent below saturation target range (25).…”

“…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)).…”

“…In addition, an overall reduction of manual interventions during automated control was found in these studies, indicating facilitation of caretakers and nursing staff in clinical routine The first two authors contributed equally to this work. Articles Hütten et al (27,28). However, at least one study raised concerns about safety, as time within target range was accompanied by an increase in time spent below saturation target range (25).…”

Diseño de un sistema médico asistencial de autorregulación de oxígeno por monitoreo no invasivo, basado en lógica difusa

“…Por otra parte, la oxigenación insuficiente también ha sido asociada con efectos perjudiciales en el cerebro, problemas pulmonares y permeabilidad del ducto arterioso [8,5].…”