Role of automation in neonatal respiratory support

Abstract

Premature infants frequently present with respiratory instability, which is associated with fl uctuations in ventilation and gas exchange. Adjustment of respiratory support to the infant ' s needs is limited by staff availability and workload. Hence, automation is being explored as a way to improve the care of the premature infants. New modes of automatic respiratory support are being developed and becoming available for clinical use in preterm infants. These modes are expected to compensate for some of the limitations that presently exist in the conventional forms of respiratory support. Available evidence and preliminary fi ndings are promising, but further investigation is needed to determine the effects of these modalities on the long-term outcome of preterm infants.

The effect of implementing an automated oxygen control on oxygen saturation in preterm infants

“…Although difficult to measure, during evaluations nurses reported that after implementation of the automated FiO 2 control their workload was less and they would be very reluctant to go back to the manual titration. Studies have reported that automated FiO 2 control decreased the required nursing time in preterm infants with frequent severe desaturations 20 24 25. However, thresholds should be set very carefully in order not to mask deterioration of a patient and nurses needs to stay attentive as well as the automated FiO 2 control should give a warning if the FiO 2 baseline rises above a predefined level.…”

“…Randomised trials comparing automated FiO 2 systems with manual titration for short periods demonstrated an increase in the proportion of time spent with SpO 2 within target range varying between 8% and 24% 20–23. Automated FiO 2 control also decreased the required nursing time in preterm infants with frequent severe desaturations 20 24 25. However, the use of automated FiO 2 control for longer periods has not been investigated.…”

Remote Closed-Loop Automatic Oxygen Control in Preterm Infants

“…The previous studies have shown some risks related to development of mechanized control systems in oxygen therapy for respiratory complicated patients (1,3,5). Therefore, a system was designed and implemented that could easily and promptly warn nurses based on patients' condition.…”

“…Adjustment of respiratory support within the clinically intended range of SPO 2 is affected by some factors like routine manual control (RMC) by clinical staff and their respond to SPO 2 frequent fluctuations. It is clear that a higher nurse-to-patient ratio can improve achievement of oxygenation targets by preventing neonate from spending long time above the clinically intended range of SPO 2 (1,5).…”

Designing a Remote Closed-Loop Automatic Oxygen Control in Preterm Infants

“…Adjustment of respiratory support within the clinically intended range of SPO 2 is affected by some factors like routine manual control (RMC) by clinical staff and their responses to SPO 2 frequent fluctuations. It is clear that a higher nurse-to-patient ratio can improve the achievement of oxygenation targets by preventing neonates from spending a long time above the clinically intended range of SPO 2 (1,5).…”