Oxygen Saturation Targeting in Preterm Infants Receiving Continuous Positive Airway Pressure

K, Lim; Wheeler, Kevin; Gale, Timothy J.; Jackson, Hamish; Kihlstrand, Jonna F.; Sand, Cajsa; Dawson, Jennifer A; Dargaville, Peter A.

doi:10.1016/j.jpeds.2013.11.072

Cited by 100 publications

(88 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All studies except one were conducted in high‐income settings. These studies showed that, with manual titration, SpO 2 was outside and/or above the target range 18–84% and 15–58% of time, respectively 15, 16, 17, 18, 19, 20, 21, 22, 25, 26. In Colombia, SpO 2 was within or above the target 34 and 55% of the time, respectively 21.…”

mentioning

confidence: 98%

Pulse oximetry values of neonates admitted for care and receiving routine oxygen therapy at a resource‐limited hospital in Kenya

Morgan

Maina

Waiyego

et al. 2017

J Paediatrics Child Health

View full text Add to dashboard Cite

AimThere are 2.7 million neonatal deaths annually, 75% of which occur in sub‐Saharan Africa and South Asia. Effective treatment of hypoxaemia through tailored oxygen therapy could reduce neonatal mortality and prevent oxygen toxicity.MethodsWe undertook a two‐part prospective study of neonates admitted to a neonatal unit in Nairobi, Kenya, between January and December 2015. We determined the prevalence of hypoxaemia and explored associations of clinical risk factors and signs of respiratory distress with hypoxaemia and mortality. After staff training on oxygen saturation (SpO2) target ranges, we enrolled a consecutive sample of neonates admitted for oxygen and measured SpO2 at 0, 6, 12, 18 and 24 h post‐admission. We estimated the proportion of neonates outside the target range (≥34 weeks: ≥92%; <34 weeks: 89–93%) with 95% confidence intervals (CIs).ResultsA total of 477 neonates were enrolled. Prevalence of hypoxaemia was 29.2%. Retractions (odds ratio (OR) 2.83, 95% CI 1.47–5.47), nasal flaring (OR 2.68, 95% CI 1.51–4.75), and grunting (OR 2.47, 95% CI 1.27–4.80) were significantly associated with hypoxaemia. Nasal flaring (OR 2.85, 95% CI 1.25–6.54), and hypoxaemia (OR 3.06, 95% CI 1.54–6.07) were significantly associated with mortality; 64% of neonates receiving oxygen were out of range at ≥2 time points and 43% at ≥3 time points.ConclusionThere is a high prevalence of hypoxaemia at admission and a strong association between hypoxaemia and mortality in this Kenyan neonatal unit. Many neonates had out of range SpO2 values while receiving oxygen. Further research is needed to test strategies aimed at improving the accuracy of oxygen provision in low‐resource settings.

show abstract

mentioning

confidence: 98%

Pulse oximetry values of neonates admitted for care and receiving routine oxygen therapy at a resource‐limited hospital in Kenya

Morgan

Maina

Waiyego

et al. 2017

J Paediatrics Child Health

View full text Add to dashboard Cite

show abstract

“…Nurses from one of the centers identified several factors as important in targeting a specific saturation range, including: (1) education; (2) prompt response times; and (3) a favorable nurseto-patient ratio. 26 Targets in the Canadian trial were achieved significantly more often than in other randomized studies, 25,27 even though those studies also used educational interventions and process algorithms. 24,28 Even in studies in which favorable nurse-to-patient ratios were believed to exist, infants spent 33% to 38% of the time outside their target ranges.…”

Section: Personnelmentioning

confidence: 90%

“…31,32 Better tracking of saturation targeting can be accomplished by using third-party data extraction technology 33 or by using the histogram feature available on some monitoring equipment. 27,34 …”

Section: Personnelmentioning

confidence: 99%

Oxygen Targeting in Extremely Low Birth Weight Infants

Cummings¹,

Polin²,

Newborn³

2016

Pediatrics

108

View full text Add to dashboard Cite

The use of supplemental oxygen plays a vital role in the care of the critically ill preterm infant, but the unrestricted use of oxygen can lead to unintended harms, such as chronic lung disease and retinopathy of prematurity. An overly restricted use of supplemental oxygen may have adverse effects as well. Ideally, continuous monitoring of tissue and cellular oxygen delivery would allow clinicians to better titrate the use of supplemental oxygen, but such monitoring is not currently feasible in the clinical setting. The introduction of pulse oximetry has greatly aided the clinician by providing a relatively easy and continuous estimate of arterial oxygen saturation, but pulse oximetry has several practical, technical, and physiologic limitations. Recent randomized clinical trials comparing different pulse oximetry targets have been conducted to better inform the practice of supplemental oxygen use. This clinical report discusses the benefits and limitations of pulse oximetry for assessing oxygenation, summarizes randomized clinical trials of oxygen saturation targeting, and addresses implications for practice.

show abstract

“…Although we have limited knowledge as to how much oxygen these patients actually need, or how much oxygen is safe to give, it is in the best interest of the patient to adjust the FiO 2 level in as close to real time as possible [1][2][3]5]. Lim et al [6] compared the effectiveness of oxygen therapy in preterm infants via manual FiO 2 adjustment against automatic FiO 2 adjustment. The results concluded that automatic FiO 2 adjustment meant infant patients required less average oxygen content in order to maintain an SpO 2 level within an appropriate range.…”

Section: Introductionmentioning

confidence: 99%

“…Because SpO 2 can be monitored nearly in real time, an automatic control system for FiO 2 can be designed and implemented [7,8]. However, control algorithms [6][7][8] are still subject to rulebased control that could cause an abrupt change in the FiO 2 level. In many situations, an abrupt change in FiO 2 level could cause an unstable SpO 2 level and reduce the benefit of oxygen therapy.…”

Section: Introductionmentioning

confidence: 99%

Automatic Control of Fraction of Inspired Oxygen in Neonatal Oxygen Therapy using Fuzzy Logic Control

Chanyagorn

Kiratiwudhikul

2016

IEIE Transactions on Smart Processing and Computing

View full text Add to dashboard Cite

Premature babies of less than 37 weeks gestation might require oxygen therapy as an integral part of treatment and respiratory support. Because of their under-developed lungs, these socalled "preemies" might contract respiratory distress syndrome (RDS). To treat RDS, neonatal oxygen therapy is administered, where controlled oxygen gas is measured as a fraction of inspired oxygen (FiO 2 ). However, exposure to high oxygen content during long treatment could cause oxygen intoxication, which might cause permanent blindness due to retinopathy of prematurity (ROP), whereas insufficient oxygen exposure could cause severe hypoxia. A doctor would use oxygen saturation (SpO 2 ) data and prescribe a dose of FiO 2 to maintain SpO 2 within a suitable range. One objective is to maintain SpO 2 within the acceptable range using FiO 2 that is as low as possible. Adjustment of FiO 2 would normally be done by nurses every 15 to 30 minutes, which might not be safe in many situations. An error in FiO 2 adjustment during a manual procedure could be as large as +/-2.5%. This paper presents a system that can determine an FiO 2 value suitable to the current SpO 2 and that automatically adjusts FiO 2 with an error clearance of +/-0.25%.

show abstract

Oxygen Saturation Targeting in Preterm Infants Receiving Continuous Positive Airway Pressure

Cited by 100 publications

References 25 publications

Pulse oximetry values of neonates admitted for care and receiving routine oxygen therapy at a resource‐limited hospital in Kenya

Pulse oximetry values of neonates admitted for care and receiving routine oxygen therapy at a resource‐limited hospital in Kenya

Oxygen Targeting in Extremely Low Birth Weight Infants

Automatic Control of Fraction of Inspired Oxygen in Neonatal Oxygen Therapy using Fuzzy Logic Control

Contact Info

Product

Resources

About