Automated control of oxygen titration in preterm infants on non-invasive respiratory support

Dargaville, Peter A.; Marshall, Andrew; Ladlow, Oliver J; Bannink, Charlotte; Jayakar, Rohan; Eastwood‐Sutherland, Caillin; K, Lim; Ali, Sanoj K M; Gale, Timothy J.

doi:10.1136/archdischild-2020-321538

Cited by 21 publications

(18 citation statements)

References 33 publications

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“…In our study, the proportion of time spent in the hyperoxaemic range was lower in the A-Fio 2 arm, but this difference was not statistically significant. This is unlike the previous studies that have shown a statistically significant reduction in the hyperoxaemia 8–12 15 16. This may be due to the enhanced awareness among staff regarding the importance of the Spo 2 targeting in preterm infants 23.…”

Section: Discussioncontrasting

confidence: 73%

“…It is now possible to control the Fio 2 using automatic technology. Several studies have consistently shown that automatic oxygen control (A-Fio 2 ) improves compliance with Spo 2 targeting8–15 and reduces hypoxaemia11–13 15 16 and hyperoxaemia8–12 15 16 in preterm infants on respiratory support. However, the trials were of short duration.…”

Section: Introductionmentioning

confidence: 99%

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Automatic oxygen control for reducing extremes of oxygen saturation: a randomised controlled trial

Nair

Loganathan

Lal

et al. 2022

Arch Dis Child Fetal Neonatal Ed

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ObjectiveThe objective of this study was to evaluate the efficacy of the automatic oxygen control (A-Fio2) in reducing the percentage of time spent in severe hypoxaemia (Spo2 <80%) in preterm infants for the time period on invasive ventilation and/or nasal continuous positive airway pressure (NCPAP) delivered by AVEA ventilator.DesignA parallel arm randomised controlled trial.SettingA level-III neonatal intensive care unit.PatientsPreterm infants (<33 weeks birth gestation) who received invasive ventilation or NCPAP in the first 72 hours of age.InterventionsA-Fio2 vs manual (M-Fio2) oxygen control.OutcomesThe primary outcome of the study was percentage of time spent in severe hypoxaemia (Spo2 <80%).Results44 infants were randomised to either A-Fio2 or M-Fio2 arm and continued in the study for the period of respiratory support (invasive ventilation and/or NCPAP). The total number of study days in A-Fio2 and M-Fio2 arm were 194 and 204 days, respectively. The percentage of time spent in Spo2 <80% was significantly lower with A-Fio2 compared with M-Fio2 (median of 0.1% (IQR: 0.07–0.7) vs 0.6% (0.2–2); p=0.03). The number of prolonged episodes (>60 s) of Spo2 <80% per day was also significantly lower in A-Fio2 (0.3 (0.0–2) vs 2 (0.6–6); p=0.02).ConclusionA-Fio2 was associated with statistically significant reduction in the percentage of time spent in severe hypoxaemia when compared with M-Fio2 in preterm infants receiving respiratory support.Trial registration numberNCT04223258.

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Section: Discussioncontrasting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Automatic oxygen control for reducing extremes of oxygen saturation: a randomised controlled trial

Nair

Loganathan

Lal

et al. 2022

Arch Dis Child Fetal Neonatal Ed

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“…It is often perceived at the bedside that FiO2 tends to be higher with A-FiO2 than M-FiO2. Some cross over studies with A-FiO2, did not show any statistical difference in the median FiO2 (32,36,42), was lower in A-FiO2 arm in Claure et al's study (31) and higher in Dijkman et al's study using PRICO (45).…”

Section: Average Fio2mentioning

confidence: 80%

“…The details of the currently available studies are shown in Table 1 (29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45). Majority of these studies were cross-over RCT.…”

Section: Current Available Evidence For the Use Of A-fio2 In Neonatesmentioning

confidence: 99%

Automated Oxygen Delivery in Neonatal Intensive Care

Nair

Loganathan²,

Lal³

et al. 2022

Front. Pediatr.

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Oxygen is the most common drug used in the neonatal intensive care. It has a narrow therapeutic range in preterm infants. Too high (hyperoxemia) or low oxygen (hypoxemia) is associated with adverse neonatal outcomes. It is not only prudent to maintain oxygen saturations in the target range, but also to avoid extremes of oxygen saturations. In routine practice when done manually by the staff, it is challenging to maintain oxygen saturations within the target range. Automatic control of oxygen delivery is now feasible and has shown to improve the time spent with in the target range of oxygen saturations. In addition, it also helps to avoid extremes of oxygen saturation. However, there are no studies that evaluated the clinical outcomes with automatic control of oxygen delivery. In this narrative review article, we aim to present the current evidence on automatic oxygen control and the future directions.

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“…Questions remain regarding the scalability of this technology to the wider population and the need for large sample long-term follow-up studies ( 97 ), but equally, NAVA could represent an effective way of both measuring and responding to apnoeic events as they occur. Moreover, automated oxygen titration systems are beginning to be used in some NICUs following recent work highlighting their safety ( 100 ). The impact of these systems on AOP dynamics warrants investigation.…”

Section: Improvements In Aop Measurementmentioning

confidence: 99%

Apnoea of Prematurity and Neurodevelopmental Outcomes: Current Understanding and Future Prospects for Research

Williamson

Poorun²,

Hartley³

2021

Front. Pediatr.

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Infants who are born prematurely are at significant risk of apnoea. In addition to the short-term consequences such as hypoxia, apnoea of prematurity has been associated with long-term morbidity, including poor neurodevelopmental outcomes. Clinical trials have illustrated the importance of methylxanthine drugs, in particular caffeine, in reducing the risk of long term adverse neurodevelopmental outcomes. However, the extent to which apnoea is causative of this secondary neurodevelopmental delay or is just associated in a background of other sequelae of prematurity remains unclear. In this review, we first discuss the pathophysiology of apnoea of prematurity, previous studies investigating the relationship between apnoea and neurodevelopmental delay, and treatment of apnoea with caffeine therapy. We propose a need for better methods of measuring apnoea, along with improved understanding of the neonatal brain's response to consequent hypoxia. Only then can we start to disentangle the effects of apnoea on neurodevelopment in preterm infants. Moreover, by better identifying those infants who are at risk of apnoea, and neurodevelopmental delay, we can work toward a risk stratification system for these infants that is clinically actionable, for example, with doses of caffeine tailored to the individual. Optimising treatment of apnoea for individual infants will improve neonatal care and long-term outcomes for this population.

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Automated control of oxygen titration in preterm infants on non-invasive respiratory support

Cited by 21 publications

References 33 publications

Automatic oxygen control for reducing extremes of oxygen saturation: a randomised controlled trial

Automatic oxygen control for reducing extremes of oxygen saturation: a randomised controlled trial

Automated Oxygen Delivery in Neonatal Intensive Care

Apnoea of Prematurity and Neurodevelopmental Outcomes: Current Understanding and Future Prospects for Research

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