Automated versus manual oxygen control in preterm infants receiving respiratory support: a systematic review and meta-analysis

Abdo, Mohamed; Hanbal, Ahmed; Mostafa, Moamen; Ishqair, Anas; Alfar, Merana; Elnaiem, Walaa; Ragab, Khaled Mohamed; Nourelden, Anas Zakarya; Zaazouee, Mohamed Sayed

doi:10.1080/14767058.2021.1904875

Cited by 13 publications

(21 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hypoxaemic events are known to be associated with morbidities, mortality and long-term neurodisabilities 2 5. A-Fio 2 reduced the time spent in hypoxaemia and the magnitude of the improvement is consistent with the findings of a recent meta-analysis 20. However, the study duration of these trials ranged from 4 to 24 hours.…”

Section: Discussionsupporting

confidence: 66%

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 66%

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

View full text Add to dashboard Cite

show abstract

“…5 James Cook University Hospital, Neonatology, South Tees NHS Trust, Middlesbrough, UK. 6 Vittore Buzzi Children's Hospital, Neonatology, Milan, Italy. 7…”

Section: Discussionmentioning

confidence: 99%

“…Given the limitations of manual FiO 2 titration, automated FiO 2 control algorithms for SpO 2 have become available and studied. These studies have shown that automated control improves the time within the intended target range, and reduces time spend at the SpO 2 extremes [5,6]. It is unclear how automated FiO 2 control impacts the frequency and duration of episodes of extreme hypoxemia and hyperoxemia.…”

Section: Introductionmentioning

confidence: 99%

Frequency and duration of extreme hypoxemic and hyperoxemic episodes during manual and automatic oxygen control in preterm infants: a retrospective cohort analysis from randomized studies

et al. 2022

View full text Add to dashboard Cite

Objective Neonatal exposure to episodic hypoxemia and hyperoxemia is highly relevant to outcomes. Our goal was to investigate the differences in the frequency and duration of extreme low and high SpO2 episodes between automated and manual inspired oxygen control. Design Post-hoc analysis of a cohort from prospective randomized cross-over studies. Setting Seven tertiary care neonatal intensive care units. Patients Fifty-eight very preterm neonates (32 or less weeks PMA) receiving respiratory support and supplemental oxygen participating in an automated versus manual oxygen control cross-over trial. Main measures Extreme hypoxemia was defined as a SpO2 < 80%, extreme hyperoxemia as a SpO2 > 98%. Episode duration was categorized as < 5 seconds, between 5 to < 30 seconds, 30 to < 60 seconds, 60 to < 120 seconds, and 120 seconds or longer. Results The infants were of a median postmenstrual age of 29 (28-31) weeks, receiving a median FiO2 of 0.28 (0.25-0.32) with mostly receiving non-invasive respiratory support (83%). While most of the episodes were less than 30 seconds, longer episodes had a marked effect on total time exposure to extremes. The time differences in each of the three longest durations episodes (30, 60, and 120 seconds) were significantly less during automated than during manual control (p < 0.001). Nearly two-third of the reduction of total time spent at the extremes between automated and manual control (3.8 to 2.1% for < 80% SpO2 and 3.0 to 1.6% for > 98% SpO2) was seen in the episodes of at least 60 seconds. Conclusions This study shows that the majority of episodes preterm infants spent in SpO2 extremes are of short duration regardless of manual or automated control. However, the infrequent longer episodes not only contribute the most to the total exposure, but also their reduction in frequency to the improvement associated with automated control.

show abstract

“…The studies consistently reported significantly higher proportion of time in SpO2 TR, lower proportion of time below & above the SpO2 TR and reduced need for manual adjustments with A-FiO2. In a recent systematic review with 13 studies, A-FiO2 resulted in increased time spent in target SpO2 of 85–96% [MD = 8.96; 95% CI (6.26, 11.67), p < .00001], and 90–95% [MD = 18.25; 95% CI (4.58, 31.65), p = 0.008] ( 46 ). A-FiO2 reduced the time in hypoxemia [SpO2 < 85%; MD = −1.24; 95% CI (−2.05, −0.43), p = 0.003] and hyperoxemia [SpO2 > 98%; MD = −0.99; 95% CI (−1.74, −0.25), p = 0.009].…”

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.

View full text Add to dashboard Cite

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.

show abstract

Automated versus manual oxygen control in preterm infants receiving respiratory support: a systematic review and meta-analysis

Cited by 13 publications

References 36 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

Frequency and duration of extreme hypoxemic and hyperoxemic episodes during manual and automatic oxygen control in preterm infants: a retrospective cohort analysis from randomized studies

Automated Oxygen Delivery in Neonatal Intensive Care

Contact Info

Product

Resources

About