Cerebral and splanchnic oxygenation during automated control of inspired oxygen (FiO2) in preterm infants

Dani, Carlo; Pratesi, Simone; Luzzati, Michele; Petrolini, Chiara; Montano, Simona; Remaschi, Giulia; Coviello, Caterina

doi:10.1002/ppul.25379

Cited by 10 publications

(13 citation statements)

References 24 publications

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“…Mean values of FOEL (0.15 ± 0.07) was lower than that reported for cerebral (0.18−0.32), 26 renal (0.13−0.33), 33 and splanchnic (0.30−0.50) 30 tissues. This result is consistent with the high value of rSO 2 L and suggests that the good lung oxygenation of our patients was balanced by a lower extraction of oxygen from the blood.…”

Section: Discussioncontrasting

confidence: 64%

Measurement of lung oxygenation by near‐infrared spectroscopy in preterm infants with respiratory distress syndrome: A proof‐of‐concept study

Dani

Ciarcià

Miselli

et al. 2022

Pediatric Pulmonology

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Introduction: Noninvasive markers more accurate than FiO 2 would be useful to assess the severity of RDS and guide its treatment. Our aim was to assess for the first time the possibility of continuously monitoring lung oxygenation (rSO 2 L) by near-infrared spectroscopy (NIRS) and to evaluate whether rSO 2 L correlates with other oxygenation indices and RDS severity. Methods:We carried out this proof-of-concept study on 20 preterm infants with RDS requiring noninvasive respiratory support. Patients were continuously studied for 24 h by NIRS and rSO 2 L was correlated with SpO 2 /FiO 2 ratio, a/APO 2 , and O.I. Results:The overall value of rSO 2 L was 80.1 ± 6.2%, without significant differences between the right and left hemithorax (80.2 ± 6.7 vs. 80.0 ± 5.7%; p = 0.869). Mean values of total, right, and left rSO 2 L did not significantly change during the 24-h study period. Linear regression analysis demonstrated a significant positive relationship between total rSO 2 L and SpO 2 /FiO 2 ratio (p < 0.001) and a/APO 2 (p = 0.040), and a negative relationship between total rSO 2 L and O.I. (r = −0.309; p = 0.022).Conclusions: Continuous monitoring of rSO 2 L by NIRS in preterm infants with RDS is feasible and safe. The correlation of rSO 2 L with other indices of oxygenation and RDS severity supports the accuracy and reliability of this measurement.

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Section: Discussioncontrasting

confidence: 64%

Measurement of lung oxygenation by near‐infrared spectroscopy in preterm infants with respiratory distress syndrome: A proof‐of‐concept study

Dani

Ciarcià

Miselli

et al. 2022

Pediatric Pulmonology

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“…Another randomized 12 h crossover study in 20 patients studied the effect of PRICO on cerebral and splanchnic tissue oxygenation and found no significant differences in regional tissue oxygenation with PRICO. This study did report a time percentage spent within SpO2 target range as a secondary outcome and found an increase of 16.0% (95% CI 4.7–27.3) in favor of PRICO but was not adequately powered for this outcome [17]. This makes our current study the first to report a consistent and powered effect of the PRICO algorithm in preterm infants on different modes of respiratory support.…”

Section: Discussionmentioning

confidence: 74%

“…One randomized crossover trial investigated the efficacy of PRICO in improving time within SpO2 target range in preterm infants exclusively on high flow nasal cannula [16]. Another randomized study investigated the effect of PRICO on cerebral and splanchnic oxygenation [17]. Therefore, we conducted a two-center study to investigate the feasibility and efficacy of PRICO in maintaining SpO2 within the target range in preterm infants on different modes of invasive and noninvasive respiratory support.…”

Section: Introductionmentioning

confidence: 99%

Predictive Intelligent Control of Oxygenation in Preterm Infants: A Two-Center Feasibility Study

et al. 2022

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Introduction: Supplemental oxygen therapy is a mainstay of modern neonatal intensive care for preterm infants. However, both insufficient and excess oxygen delivery are associated with adverse outcomes. Automated or closed loop FiO2 control has been developed to keep SpO2 within a predefined target range more effectively. Methods: The aim of this study was to investigate the feasibility of closed loop FiO2 control by Predictive Intelligent Control of Oxygenation (PRICO) on the Fabian ventilator in maintaining SpO2 within a target range (88/89-95%) in preterm infants on different modes of invasive and noninvasive respiratory support. In two tertiary neonatal intensive care units, preterm infants with an FiO2 >0.21 were included and received an 8 h nonblinded treatment period of closed loop FiO2 control by PRICO, flanked by two 8 h control periods of routine manual control (RMC1 and RMC2). Results: 32 preterm infants were included (median gestational age 26 + 5 weeks [IQR 25 + 5–27 + 6], median birthweight 828 grams [IQR 704–930]). Six patients received invasive respiratory support, while 26 received noninvasive respiratory support (18 CPAP, 4 DuoPAP, and 4 nasal IMV). The time percentage within the SpO2 target range was increased with PRICO (74.4% [IQR 67.8–78.5]) compared to RMC1 (65.8% [IQR 51.1–77.8]; p = 0.011) and RMC2 (60.6% [IQR 56.2–66.6]; p < 0.001) with an estimated median difference of 6.0% (95% CI 1.2–11.5) and 9.8% (95% CI 6.0–13.0), respectively. Conclusion: In preterm infants on invasive and noninvasive respiratory supports, closed loop FiO2 control by PRICO compared to RMC is feasible and superior in maintaining SpO2 within target ranges.

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“…An improvement in saturation targeting with A-FiO2 was not associated with improved tissue oxygenation in studies by Dani et al and Waitz et al (37,49).…”

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

confidence: 88%

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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Cerebral and splanchnic oxygenation during automated control of inspired oxygen (FiO₂) in preterm infants

Cited by 10 publications

References 24 publications

Measurement of lung oxygenation by near‐infrared spectroscopy in preterm infants with respiratory distress syndrome: A proof‐of‐concept study

Measurement of lung oxygenation by near‐infrared spectroscopy in preterm infants with respiratory distress syndrome: A proof‐of‐concept study

Predictive Intelligent Control of Oxygenation in Preterm Infants: A Two-Center Feasibility Study

Automated Oxygen Delivery in Neonatal Intensive Care

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