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Title Closed-Loop Controlled Inspired Oxygen Concentration for Mechanically Ventilated Very Low Birth Weight Infants With Frequent Episodes of Hypoxemia
Author(s) Nelson Claure, Tilo Gerhardt, Ruth Everett, Gabriel Musante, Carmen Herrera, and Eduardo Bancalari
Source Pediatrics, Vol. 107, No. 5, Pages 1120-1124
Publication Date May, 2001
Abstract Background. Mechanically ventilated very low birth weight infants often present with frequent episodes of hypoxemia, and maintaining arterial oxygen saturation by pulse oximetry (SpO2) within a normal range by manual fraction of inspired oxygen (FIO2) adjustments is difficult and time consuming. Objectives. An algorithm for closed-loop FIO2 control (cFIO2) to maintain SpO2 within a target range was compared with continuous manual FIO2 (mFIO2) adjustments by a nurse in a group of ventilated infants who presented with frequent episodes of hypoxemia. Results. Fourteen infants (birth weight: 712 142 g; gestational age: 25 1.6 weeks; age: 26 11 days; synchronized intermittent mandatory ventilation rate: 24 10 b/m; peak inspiratory pressure: 17.5 2.0 cmH2O; positive end-expiratory pressure: 4.3 0.5 cmH2O) were studied for 2 hours on each mode in random sequence. Both modes aimed to maintain SpO2 between 88% and 96%. There were 15 7 and 16 6 hypoxemic episodes/hour (SpO2 <88%, >5 s) during mFIO2 and cFIO2, respectively; episode duration was 41 23 and 32 15 s, totaling 19 16% and 17 12% of recording time. There were 13 10 and 10 8 hyperoxemic episodes/hour (SpO2>96%, >5 s) during mFIO2 and cFIO2, respectively; episode duration was 27 15 and 24 19 s, totaling 15 14% and 10 9% of recording time. Mean SpO2 and FIO2 levels were similar during both modes. The nurse made 29 17 adjustments/hour during mFIO2. There was a significant increase in the duration of normoxemia (SpO2 between 88%-96%) during cFIO2 (75 13 vs 66 14% of recording time). Conclusion. In this group of infants, cFIO2 was at least as effective as a fully dedicated nurse in maintaining SpO2 within the target range, and it may be more effective than a nurse working under routine conditions. We speculate that during long-term use, cFIO2 may save nursing time and reduce the risks of morbidity associated with supplemental oxygen and episodes of hypo- and hyperoxemia.

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