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Automated FiO(2)-SpO(2) control system in Neonates requiring respiratory support: a comparison of a standard to a narrow SpO(2) control range

BACKGROUND: Managing the oxygen saturation of preterm infants to a target range has been the standard of care for a decade. Changes in target ranges have been shown to significantly impact mortality and morbidity. Selecting and implementing the optimal target range are complicated not only by issues...

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Autores principales: Wilinska, Maria, Bachman, Thomas, Swietlinski, Janusz, Kostro, Maria, Twardoch-Drozd, Marta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4042130/
https://www.ncbi.nlm.nih.gov/pubmed/24885124
http://dx.doi.org/10.1186/1471-2431-14-130
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author Wilinska, Maria
Bachman, Thomas
Swietlinski, Janusz
Kostro, Maria
Twardoch-Drozd, Marta
author_facet Wilinska, Maria
Bachman, Thomas
Swietlinski, Janusz
Kostro, Maria
Twardoch-Drozd, Marta
author_sort Wilinska, Maria
collection PubMed
description BACKGROUND: Managing the oxygen saturation of preterm infants to a target range has been the standard of care for a decade. Changes in target ranges have been shown to significantly impact mortality and morbidity. Selecting and implementing the optimal target range are complicated not only by issues of training, but also the realities of staffing levels and demands. The potential for automatic control is becoming a reality. Results from the evaluation of different systems have been promising and our own experience encouraging. METHODS: This study was conducted in two tertiary level newborn nurseries, routinely using an automated FiO(2)-SpO(2) control system (Avea-CLiO2, Yorba Linda CA, USA). The aim of this study was to compare the performance of the system as used routinely (set control range of 87-93% SpO(2)), to a narrower higher range (90-93%). We employed a 12-hour cross-over design with the order of control ranges randomly assigned for each of up to three days. The primary prospectively identified end points were time in the 87-93% SpO(2) target range, time at SpO(2) extremes and the distribution of the SpO(2) exposure. RESULTS: Twenty-one infants completed the study. The infants were born with a median EGA of 27 weeks and studied at a median age of 17 days and weight of 1.08 kg. Their median FiO(2) was 0.32; 8 were intubated, and the rest noninvasively supported (7 positive pressure ventilation and 6 CPAP). The control in both arms was excellent, and required less than 2 manual FiO2 adjustments per day. There were no differences in the three primary endpoints. The narrower/higher set control range resulted in tighter control (IQR 3.0 vs. 4.3 p < 0.001), and less time with the SpO(2) between 80–86 (6.2% vs. 8.4%, p = 0.006). CONCLUSIONS: We found that a shift in the median of the set control range of an automated FiO(2)-SpO(2) control system had a proportional effect on the median and distribution of SpO2 exposure. We found that a dramatic narrowing of the set control range had a disproportionally smaller impact. Our study points to the potential to optimize SpO(2) targeting with an automated control system.
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spelling pubmed-40421302014-06-04 Automated FiO(2)-SpO(2) control system in Neonates requiring respiratory support: a comparison of a standard to a narrow SpO(2) control range Wilinska, Maria Bachman, Thomas Swietlinski, Janusz Kostro, Maria Twardoch-Drozd, Marta BMC Pediatr Research Article BACKGROUND: Managing the oxygen saturation of preterm infants to a target range has been the standard of care for a decade. Changes in target ranges have been shown to significantly impact mortality and morbidity. Selecting and implementing the optimal target range are complicated not only by issues of training, but also the realities of staffing levels and demands. The potential for automatic control is becoming a reality. Results from the evaluation of different systems have been promising and our own experience encouraging. METHODS: This study was conducted in two tertiary level newborn nurseries, routinely using an automated FiO(2)-SpO(2) control system (Avea-CLiO2, Yorba Linda CA, USA). The aim of this study was to compare the performance of the system as used routinely (set control range of 87-93% SpO(2)), to a narrower higher range (90-93%). We employed a 12-hour cross-over design with the order of control ranges randomly assigned for each of up to three days. The primary prospectively identified end points were time in the 87-93% SpO(2) target range, time at SpO(2) extremes and the distribution of the SpO(2) exposure. RESULTS: Twenty-one infants completed the study. The infants were born with a median EGA of 27 weeks and studied at a median age of 17 days and weight of 1.08 kg. Their median FiO(2) was 0.32; 8 were intubated, and the rest noninvasively supported (7 positive pressure ventilation and 6 CPAP). The control in both arms was excellent, and required less than 2 manual FiO2 adjustments per day. There were no differences in the three primary endpoints. The narrower/higher set control range resulted in tighter control (IQR 3.0 vs. 4.3 p < 0.001), and less time with the SpO(2) between 80–86 (6.2% vs. 8.4%, p = 0.006). CONCLUSIONS: We found that a shift in the median of the set control range of an automated FiO(2)-SpO(2) control system had a proportional effect on the median and distribution of SpO2 exposure. We found that a dramatic narrowing of the set control range had a disproportionally smaller impact. Our study points to the potential to optimize SpO(2) targeting with an automated control system. BioMed Central 2014-05-28 /pmc/articles/PMC4042130/ /pubmed/24885124 http://dx.doi.org/10.1186/1471-2431-14-130 Text en Copyright © 2014 Wilinska et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Wilinska, Maria
Bachman, Thomas
Swietlinski, Janusz
Kostro, Maria
Twardoch-Drozd, Marta
Automated FiO(2)-SpO(2) control system in Neonates requiring respiratory support: a comparison of a standard to a narrow SpO(2) control range
title Automated FiO(2)-SpO(2) control system in Neonates requiring respiratory support: a comparison of a standard to a narrow SpO(2) control range
title_full Automated FiO(2)-SpO(2) control system in Neonates requiring respiratory support: a comparison of a standard to a narrow SpO(2) control range
title_fullStr Automated FiO(2)-SpO(2) control system in Neonates requiring respiratory support: a comparison of a standard to a narrow SpO(2) control range
title_full_unstemmed Automated FiO(2)-SpO(2) control system in Neonates requiring respiratory support: a comparison of a standard to a narrow SpO(2) control range
title_short Automated FiO(2)-SpO(2) control system in Neonates requiring respiratory support: a comparison of a standard to a narrow SpO(2) control range
title_sort automated fio(2)-spo(2) control system in neonates requiring respiratory support: a comparison of a standard to a narrow spo(2) control range
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4042130/
https://www.ncbi.nlm.nih.gov/pubmed/24885124
http://dx.doi.org/10.1186/1471-2431-14-130
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