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Automatic Control of the Inspired Oxygen Fraction in Preterm Infants

A Randomized Crossover Trial

Department of Neonatology, and Department of Medical Biometry, Tuebingen University Hospital, Tuebingen, Germany; Department of Medical Cybernetics and Artificial Intelligence, and Department of Pediatrics and Adolescent Medicine, Medical University Vienna; and Institute of Software Technology and Interactive Systems, Vienna University of Technology, Vienna, Austria

Correspondence and requests for reprints should be addressed to Prof. Christian F. Poets, M.D., Dept. of Neonatology, Tuebingen University Hospital, Calwerstr. 7, 72076 Tuebingen, Germany. E-mail: cfpoets{at}med.uni-tuebingen.de

In preterm infants receiving supplemental oxygen, manual control of the inspired oxygen fraction is often time-consuming and inappropriate. We developed a system for automatic oxygen control and hypothesized that this system is more effective than routine manual oxygen control in maintaining target arterial oxygen saturation levels. We performed a randomized controlled crossover clinical trial in 12 preterm infants receiving nasal continuous positive airway pressure and supplemental oxygen. Periods with automatic and routine manual oxygen control were compared with periods of optimal control by a fully dedicated person. The median (range) percentage of time with arterial oxygen saturation levels within target range (87–96%) was 81.7% (39.0–99.8) for routine manual oxygen control, 91.0% (41.4–99.3) for optimal control, and 90.5% (59.0–99.4) for automatic control (ANOVA: p = 0.01). Pairwise post hoc comparisons revealed a statistically significant difference between automatic and routine manual oxygen control (Dunnett's test: p = 0.02). The frequency of manual oxygen adjustments was lowest in automatic control (Friedman's test: p < 0.001). Automatic oxygen control may optimize oxygen administration to preterm infants receiving nasal continuous positive airway pressure and reduce nursing time spent with oxygen control.

Key Words: closed-loop oxygen control • continuous positive airway pressure • infants • mechanical ventilation • neonatal lung disease

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