The effectiveness of automated adjustment of inspired oxygen in preterm infants receiving respiratory support compared with manual: A systematic review and metaanalysis

Abstract

Preterm infants may need supplemental oxygen due to immature lungs. Regardless of the type of oxygen therapy used, bedside clinicians frequently adjust the FiO₂ level. Automatic oxygen management is progressively developing as a viable alternative to these corrections. The purpose of this study is to compare the efficacy and safety of automated versus manual oxygen control in preterm infants receiving respiratory support. All the studies were searched from PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wan Fang, VIP, and CBM on 7 May 2022. PICOS criteria were as follows: (P) participants were preterm infants receiving respiratory support; (I) intervention was automatic oxygen control; (C) comparator mode was manual oxygen control; (O) the primary outcome was the percentage of time within the target pulse oxygen saturation range; (S) randomized clinical trials. Sixteen studies were included in this meta-analysis. The results showed that automated oxygen control can increase the percentage of time spent within the target SpO₂ range while reducing the percentage of time spent above the target SpO₂ range, the percentage time of hypoxemia, and manual FiO₂ adjustments/hour. No significant difference was observed in the percentage of time spent below the target SpO₂ range, incidence of bradycardia, and the mean SpO₂ or mean FiO₂ level. Automatic oxygen control can improve preterm infants’ oxygen saturation, reduce periods of hypoxemia and the percentage of time spent above the target SpO₂ range, and ease the workload of medical staff without affecting the mean FiO₂ and mean SpO₂ levels.

Keywords

automate / efficacy / meta-analysis / preterm infants

References

[1] AskieLM, Henderson-Smart DJ, KoH. Cochrane review: restricted versus liberal oxygen exposure for preventing morbidity and mortality in preterm or low birth weight infants. Evidence-Based Child Health Cochrane Rev J. 2010; 5(1):371-413.

[2] FathabadiOS, GaleTJ, OlivierJC, Dargaville PA. Automated control of inspired oxygen for preterm infants: what we have and what we need. Biomed Signal Process Control. 2016; 28:9-18.

[3] AskieLM, DarlowBA, FinerN, et al. Association between oxygen saturation targeting and death or disability in extremely preterm infants in the neonatal oxygenation prospective meta-analysis collaboration. JAMA. 2018; 319(21):2190-2201.

[4] RogowskiJA, Staiger D, PatrickT, HorbarJ, KennyM, LakeET. Nurse staffing and NICU infection rates. JAMA Pediatr. 2013; 167(5):444-450.

[5] LaptookAR, SalhabW, AllenJ, Saha S, WalshM. Pulse oximetry in very low birth weight infants: can oxygen saturation be maintained in the desired range? J Perinatol. 2006; 26(6):337-341.

[6] LimK, Wheeler KI, GaleTJ, et al. Oxygen saturation targeting in preterm infants receiving continuous positive airway pressure. J Pediatr. 2014; 164(4):730-736.e1.

[7] SinkDW, HopeSA, HagadornJI. Nurse:patient ratio and achievement of oxygen saturation goals in premature infants. Arch Dis Child Fetal Neonatal Ed. 2011; 96(2): F93-F98.

[8] MitraS, SinghB, El-NaggarW, McMillan DD. Automated versus manual control of inspired oxygen to target oxygen saturation in preterm infants: a systematic review and meta-analysis. J Perinatol. 2018; 38(4):351-360.

[9] MitraS, McMillan D. Automated control of fraction of inspired oxygen: is it time for widespread adoption? Curr Opin Pediatr. 2021; 33(2):209-216.

[10] PageMJ, McKenzie JE, BossuytPM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71.

[11] ShiJ, LuoD, WanX, et al. Detecting the skewness of data from the sample size and the five-number summary. Stat Methods Med Res. 2023; 32(7):1338-1360.

[12] WanX, WangW, LiuJ, TongT. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014; 14:1-3.

[13] ShiJ, LuoD, WengH, et al. Optimally estimating the sample standard deviation from the five-number summary. Res Synth Methods. 2020; 11(5):641-654.

[14] LuoD, WanX, LiuJ, TongT. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res. 2018; 27(6):1785-1805.

[15] DijkmanKP, MohnsT, DielemanJP, et al. Predictive Intelligent Control of Oxygenation (PRICO) in preterm infants on high flow nasal cannula support: a randomised cross-over study. Arch Dis Child Fetal Neonatal Ed. 2021; 106(6):621-626.

[16] GajdosM, WaitzM, MendlerMR, Braun W, HummlerH. Effects of a new device for automated closed loop control of inspired oxygen concentration on fluctuations of arterial and different regional organ tissue oxygen saturations in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2019; 104(4): F360-F365.

[17] van den HeuvelM, van Zanten HA, BachmanTE, Te PasAB, van Kaam AH, OnlandW. Optimal target range of closed-loop inspired oxygen support in preterm infants: a randomized cross-over study. J Pediatr. 2018; 197:36-41.

[18] van KaamAH, Hummler HD, WilinskaM, et al. Automated versus manual oxygen control with different saturation targets and modes of respiratory support in preterm infants. J Pediatr. 2015; 167(3):545-550.e1-2.

[19] WilinskaM, Bachman T, SwietlinskiJ, WaskoA, JakielG. Quicker response results in better SpO₂ control – a comparison of 3 FiO₂-titration strategies in ventilated preterm infants. Ann Agric Environ Med. 2015; 22(4):708-712.

[20] WaitzM, SchmidMB, FuchsH, Mendler MR, DreyhauptJ, HummlerHD. Effects of automated adjustment of the inspired oxygen on fluctuations of arterial and regional cerebral tissue oxygenation in preterm infants with frequent desaturations. J Pediatr. 2015; 166(2):240-244.e1.

[21] HallenbergerA, PoetsCF, HornW, Seyfang A, UrschitzMS. Closed-loop automatic oxygen control (CLAC) in preterm infants: a randomized controlled trial. Pediatrics. 2014; 133(2): e379-e385.

[22] ClaureN, Bancalari E, D’UgardC, et al. Multicenter crossover study of automated control of inspired oxygen in ventilated preterm infants. Pediatrics. 2011; 127(1): e76-e83.

[23] ClaureN, D’Ugard C, BancalariE. Automated adjustment of inspired oxygen in preterm infants with frequent fluctuations in oxygenation: a pilot clinical trial. J Pediatr. 2009; 155(5):640-645.e1-2.

[24] UrschitzMS, HornW, SeyfangA, et al. Automatic control of the inspired oxygen fraction in preterm infants: a randomized crossover trial. Am J Respir Crit Care Med. 2004; 170(10):1095-1100.

[25] ClaureN, Gerhardt T, EverettR, MusanteG, Herrera C, BancalariE. Closed-loop controlled inspired oxygen concentration for mechanically ventilated very low birth weight infants with frequent episodes of hypoxemia. Pediatrics. 2001; 107(5):1120-1124.

[26] ClarkeA, Yeomans E, ElsayedK, et al. A randomised crossover trial of clinical algorithm for oxygen saturation targeting in preterm infants with frequent desaturation episodes. Neonatology. 2015; 107(2):130-136.

[27] DargavillePA, Marshall AP, LadlowOJ, et al. Automated control of oxygen titration in preterm infants on non-invasive respiratory support. Arch Dis Child Fetal Neonatal Ed. 2022; 107(1):39-44.

[28] SchwarzCE, Kidszun A, BiederNS, et al. Is faster better? A randomised crossover study comparing algorithms for closed-loop automatic oxygen control. Arch Dis Child Fetal Neonatal Ed. 2020; 105(4):369-374.

[29] ReynoldsPR, MillerTL, VolakisLI, et al. Randomised cross-over study of automated oxygen control for preterm infants receiving nasal high flow. Arch Dis Child Fetal Neonatal Ed. 2019; 104(4): F366-F371.

[30] LalM, TinW, SinhaS. Automated control of inspired oxygen in ventilated preterm infants: crossover physiological study. Acta Paediatr. 2015; 104(11):1084-1089.

[31] FlynnJT, Bancalari E, SnyderES, et al. A cohort study of transcutaneous oxygen tension and the incidence and severity of retinopathy of prematurity. N Engl J Med. 1992; 326(16):1050-1054.

[32] Di FioreJM, WalshM, WrageL, et al. Low oxygen saturation target range is associated with increased incidence of intermittent hypoxemia. J Pediatr. 2012; 161(6):1047-1052.

[33] Di FioreJM, Kaffashi F, LoparoK, et al. The relationship between patterns of intermittent hypoxia and retinopathy of prematurity in preterm infants. Pediatr Res. 2012; 72(6):606-612.

[34] McEvoyC, DurandM, HewlettV. Episodes of spontaneous desaturations in infants with chronic lung disease at two different levels of oxygenation. Pediatr Pulmonol. 1993; 15(3):140-144.

[35] BolivarJM, Gerhardt T, GonzalezA, et al. Mechanisms for episodes of hypoxemia in preterm infants undergoing mechanical ventilation. J Pediatr. 1995; 127(5):767-773.

[36] DimaguilaMA, Di Fiore JM, MartinRJ, MillerMJ. Characteristics of hypoxemic episodes in very low birth weight infants on ventilatory support. J Pediatr. 1997; 130(4):577-583.

[37] DenaultMH, Peloquin F, LajoieAC, LacasseY. Automatic versus manual oxygen titration in patients requiring supplemental oxygen in the hospital: a systematic review and meta-analysis. Respiration. 2019; 98(2):178-188.

[38] AbdoM, HanbalA, AslaMM, et al. Automated versus manual oxygen control in preterm infants receiving respiratory support: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2021; 35(25):1-8.

[39] HagadornJI, FureyAM, NghiemTH, et al. Achieved versus intended pulse oximeter saturation in infants born less than 28 weeks’ gestation: the AVIOx study. Pediatrics. 2006; 118(4):1574-1582.

[40] MaiwaldCA, Niemarkt HJ, PoetsCF, et al. Effects of closed-loop automatic control of the inspiratory fraction of oxygen (FiO(2)-C) on outcome of extremely preterm infants - study protocol of a randomized controlled parallel group multicenter trial for safety and efficacy. BMC Pediatr. 2019; 19(1):363.

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