Automated versus manual control of inspired oxygen to target oxygen saturation in preterm infants: a systematic review and meta-analysis

Mitra, Souvik; Singh, Bhag; El-Naggar, Walid; McMillan, Douglas

doi:10.1038/s41372-017-0037-z

Cited by 55 publications

(52 citation statements)

References 30 publications

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“…Modern ventilators now also have the option of servo-controlled oxygen delivery. This increases time spent in the desired saturation range and reduces hyperoxia, but there are no trials to show this improves outcomes [115, 116]. Whatever ventilation mode is used within an individual unit, it is important that all staff are familiar with its use.…”

Section: Strategiesmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of “European Guidelines for the Management of RDS” by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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Section: Strategiesmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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“…Those results suggest automated control might identify, which patients no longer require supplementary oxygen more quickly. The results of a systematic review of automated control, however, did not demonstrate a significant difference in FiO 2 exposure or time spent below the target SpO 2 range . More evidence is required to determine whether automated control will aid weaning and in which groups of patients.…”

Section: Resultsmentioning

confidence: 96%

“…A systematic review of closed loop automated oxygen control studies found that automated control of FiO 2 resulted in a significantly higher time spent in the target saturation range (mean difference (MD) 12.8%, 95% CI 6.5%‐19.2%). It also found that automated control resulted in significantly reduced periods of hyperoxia (MD: −8.8%; 95% CI: −15 to −2.7%), severe hypoxia (MD: −0.9%; 95% CI: −1.5 to −0.4%) and the number of hypoxic events (MD: −5.6; 95% CI: −9.1 to −2.1%) . One study, however, found that automated control was associated with an increase in the number of episodes of hypoxia, although there was no increase in the episodes of extreme hypoxia (SpO 2 < 80% or < 75%) …”

Section: Resultsmentioning

confidence: 99%

“…In a crossover study, staff adjusted the FiO 2 2.3 times/hour during manual control, whereas the automated system adjusted the FiO 2 64 times/hour . The frequency of adjustments may contribute to the overall increase in target saturation achievement with automated oxygen control . No evidence, however, was available to suggest that the reduction in manual interventions resulted in neonatal practitioners having a reduced workload and hence able to use that time for other care activities.…”

Section: Resultsmentioning

confidence: 99%

“…A systematic review of clinical trials comparing closed loop automated oxygen control to manual control confirmed that these systems increase the time spent in target SpO 2 ranges in prematurely born infants . We have undertaken a literature review of closed loop automated oxygen control in neonates, aiming to determine their efficacy in those born prematurely or at term.…”

Section: Introductionmentioning

confidence: 99%

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Closed loop automated oxygen control in neonates—A review

et al. 2019

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Abbreviations: CLAC, Closed loop automatic control; CPAP, Continuous positive airway pressure; FiO 2 , Fractional concentration of inspired oxygen; MD, Mean difference; NCPAP, Nasal continuous positive airway pressure; PaO 2 , Partial pressure of oxygen in arterial blood; PID, Proportional integral differential; RDS, Respiratory distress syndrome; ROS, Reactive oxide species; SpO 2 , Oxygen saturation measured by pulse oximetry.Abstract Aim: Neonates frequently require supplementary oxygen but may develop complications if the oxygen saturation is outside the target range. This review aimed to determine whether the algorithms used in closed loop automated oxygen control systems influenced their efficacy and whether use of the systems reduced relevant, long-term neonatal complications. Methods: A literature search was conducted using PubMed and Google Scholar. The search terms were 'closed loop' or 'automat*', 'oxygen' and 'neonat*'.Results: Eighteen studies were identified: sixteen comparison clinical studies, an observational study and an animal study. Overall, closed loop automated oxygen control was associated with an increased percentage of time spent within the target oxygen saturation range and there were fewer manual adjustments to the inspired oxygen concentration when compared with manual oxygen control. The systems were effective in infants on non-invasive respiratory support or mechanically ventilated, but no study included term-born infants. No long-term data were available to determine if complications of oxygen toxicity were reduced. Conclusion:Closed loop automated oxygen control has been shown in short term trials including preterm and low birth weight infants to improve target saturation achievement. Whether long-term outcomes will be improved with their use requires investigation. K E Y W O R D Sbronchopulmonary dysplasia, closed loop automated oxygen control, neonate, retinopathy of prematurity

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Initial Oxygen Concentration for the Resuscitation of Infants Born at Less Than 32 Weeks’ Gestation

Sotiropoulos,

Oei,

Schmölzer

et al. 2024

JAMA Pediatr

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ImportanceResuscitation with lower fractional inspired oxygen (FiO2) reduces mortality in term and near-term infants but the impact of this practice on very preterm infants is unclear.ObjectiveTo evaluate the relative effectiveness of initial FiO2 on reducing mortality, severe morbidities, and oxygen saturations (SpO2) in preterm infants born at less than 32 weeks’ gestation using network meta-analysis (NMA) of individual participant data (IPD).Data SourcesMEDLINE, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, and WHO ICTRP from 1980 to October 10, 2023.Study SelectionEligible studies were randomized clinical trials enrolling infants born at less than 32 weeks’ gestation comparing at least 2 initial oxygen concentrations for delivery room resuscitation, defined as either low (≤0.3), intermediate (0.5-0.65), or high (≥0.90) FiO2.Data Extraction and SynthesisInvestigators from eligible studies were invited to provide IPD. Data were processed and checked for quality and integrity. One-stage contrast-based bayesian IPD-NMA was performed with noninformative priors and random effects and adjusted for key covariates.Main Outcomes and MeasuresThe primary outcome was all-cause mortality at hospital discharge. Secondary outcomes were morbidities of prematurity and SpO2 at 5 minutes.ResultsIPD were provided for 1055 infants from 12 of the 13 eligible studies (2005-2019). Resuscitation with high (≥0.90) initial FiO2 was associated with significantly reduced mortality compared to low (≤0.3) (odds ratio [OR], 0.45; 95% credible interval [CrI], 0.23-0.86; low certainty) and intermediate (0.5-0.65) FiO2 (OR, 0.34; 95% CrI, 0.11-0.99; very low certainty). High initial FiO2 had a 97% probability of ranking first to reduce mortality. The effects on other morbidities were inconclusive.Conclusions and RelevanceHigh initial FiO2 (≥0.90) may be associated with reduced mortality in preterm infants born at less than 32 weeks’ gestation compared to low initial FiO2 (low certainty). High initial FiO2 is possibly associated with reduced mortality compared to intermediate initial FiO2 (very low certainty) but more evidence is required.

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Automated versus manual control of inspired oxygen to target oxygen saturation in preterm infants: a systematic review and meta-analysis

Abstract: Automated FiO adjustment provides significant improvement of time in target saturations, reduces periods of hyperoxia, and severe hypoxia in preterm infants on positive pressure respiratory support.

Cited by 55 publications

References 30 publications

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

Closed loop automated oxygen control in neonates—A review

Initial Oxygen Concentration for the Resuscitation of Infants Born at Less Than 32 Weeks’ Gestation

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