Automated Adjustment of the Fraction of Inspired Oxygen (FiO2) and the Time Spent in Normoxemia in Preterm Infants.

IF 1 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL
Gustavo Rocha, Paulo Soares, Filipa Flor-de-Lima, Rita Amaral
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Abstract

Introduction: The challenge of maintaining normoxemia in preterm infants undergoing respiratory support and oxygen therapy has led to the development of closed-loop automatic control systems for FiO2. The aim of this study was to assess the effectiveness of these systems in maintaining SpO2 within a target range (90% - 94%) in preterm neonates receiving supplemental oxygen.

Methods: We conducted a single-centre prospective study over a three-year period (2020 - 2023) including preterm infants with a gestational age < 33 weeks who received supplemental oxygen within the first 24 hours of life and either invasive or non-invasive respiratory support. The closed-loop automatic control of FiO2 used was the Predictive Intelligent Control of Oxygenation feature on Fabian® ventilators. Two groups were randomized and compared, one receiving automatic plus manual control of FiO2, and the other receiving routine manual control. Uni- and multivariable regression analyses (linear or Poisson) were used to evaluate the association between the use of closed-loop automatic control of FiO2 and the parameters of manual adjustments, hypoxemia, hyperoxemia, and normoxemia.

Results: The study included 89 patients, of which 45 received automatic plus manual control of FiO2 and 44 received routine manual control. The first group required fewer manual adjustments of FiO2, experienced fewer episodes of hypoxemia and hyperoxemia (p < 0.002), and spent more time with SpO2 within the target range (p < 0.001), compared to the second group. After adjustment for confounding, the total time spent in normoxemia was higher when in automatic plus manual control of FiO2 (β = 81.5; 95%CI: 47.9 - 115.2, p < 0.001).

Conclusion: The use of closed-loop automatic control of FiO2 seems feasible and was associated with fewer episodes of hypoxia and hyperoxia, thereby maintaining SpO2 within normal limits for longer periods. Additionally, it has been shown to be associated with a reduction in manual interventions.

自动调节吸入氧分数(FiO2)和早产儿正常氧血症时间。
导论:在接受呼吸支持和氧气治疗的早产儿中维持正常氧血症的挑战导致了FiO2闭环自动控制系统的发展。本研究的目的是评估这些系统在接受补充氧的早产儿中将SpO2维持在目标范围内(90% - 94%)的有效性。方法:我们进行了一项为期三年(2020 - 2023)的单中心前瞻性研究,纳入了胎龄< 33周的早产儿,这些早产儿在出生后24小时内接受了补充氧气,并接受了有创或无创呼吸支持。使用的FiO2的闭环自动控制是Fabian®呼吸机的预测智能氧合控制功能。两组随机对照,一组接受FiO2自动加手动控制,另一组接受常规手动控制。使用单变量和多变量回归分析(线性或泊松)来评估使用闭环自动控制FiO2与手动调节参数、低氧血症、高氧血症和正常氧血症之间的关系。结果:共纳入89例患者,其中自动加手动控制FiO2 45例,常规手动控制FiO2 44例。与第二组相比,第一组需要更少的人工调整FiO2,经历更少的低氧血症和高氧血症发作(p < 0.002),并且在目标范围内花费更多的SpO2时间(p < 0.001)。校正混杂因素后,自动加手动控制FiO2时,正常氧血症总时间更长(β = 81.5;95%CI: 47.9 ~ 115.2, p < 0.001)。结论:采用闭环自动控制FiO2似乎是可行的,并且与低氧和高氧发作次数减少有关,从而使SpO2维持在正常范围内的时间更长。此外,它已被证明与减少人工干预有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Acta medica portuguesa
Acta medica portuguesa MEDICINE, GENERAL & INTERNAL-
CiteScore
1.90
自引率
16.70%
发文量
256
审稿时长
6-12 weeks
期刊介绍: The aim of Acta Médica Portuguesa is to publish original research and review articles in biomedical areas of the highest standard, covering several domains of medical knowledge, with the purpose to help doctors improve medical care. In order to accomplish these aims, Acta Médica Portuguesa publishes original articles, review articles, case reports and editorials, among others, with a focus on clinical, scientific, social, political and economic factors affecting health. Acta Médica Portuguesa will be happy to consider manuscripts for publication from authors anywhere in the world.
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